Provider Demographics
NPI:1326031444
Name:LESYK, JACK J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:J
Last Name:LESYK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21625 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5363
Mailing Address - Country:US
Mailing Address - Phone:216-575-6175
Mailing Address - Fax:216-491-0155
Practice Address - Street 1:21625 CHAGRIN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5363
Practice Address - Country:US
Practice Address - Phone:216-575-6175
Practice Address - Fax:216-491-0155
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLECP03181Medicare ID - Type Unspecified