Provider Demographics
NPI:1508927542
Name:ALLEN, LESLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N HARRISON ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3524
Mailing Address - Country:US
Mailing Address - Phone:609-924-9213
Mailing Address - Fax:609-924-9213
Practice Address - Street 1:330 N HARRISON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3524
Practice Address - Country:US
Practice Address - Phone:609-924-9213
Practice Address - Fax:609-924-9213
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03321103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8442401Medicaid
NJ8442401Medicaid
NJ045525Medicare PIN