Provider Demographics
NPI:1417032178
Name:KAMINSKI, LESLIE KAY (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:KAY
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 W SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1037
Mailing Address - Country:US
Mailing Address - Phone:602-957-0597
Mailing Address - Fax:
Practice Address - Street 1:4001 N 3RD ST
Practice Address - Street 2:150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2060
Practice Address - Country:US
Practice Address - Phone:602-957-0597
Practice Address - Fax:602-277-0668
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ109422084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry