Provider Demographics
NPI:1518307727
Name:LESKY, TERESA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:LESKY
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 1:12 CLOVER LN S
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3032
Mailing Address - Country:US
Mailing Address - Phone:973-713-3324
Mailing Address - Fax:
Practice Address - Street 1:12 CLOVER LN S
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3032
Practice Address - Country:US
Practice Address - Phone:973-713-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00389300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional