Provider Demographics
NPI:1497830285
Name:BRINKERHOFF, LESLIE JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JOHN
Last Name:BRINKERHOFF
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 1:100 S IRELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2223
Mailing Address - Country:US
Mailing Address - Phone:419-529-4124
Mailing Address - Fax:
Practice Address - Street 1:270 STERKEL BLVD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1508
Practice Address - Country:US
Practice Address - Phone:419-756-1133
Practice Address - Fax:419-756-6544
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000207517OtherANTHEM
OH000000207517OtherANTHEM