Provider Demographics
NPI:1548201056
Name:PEARL, LESLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:PEARL
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 1:19 HILL ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2113
Mailing Address - Country:US
Mailing Address - Phone:845-294-9139
Mailing Address - Fax:845-294-9139
Practice Address - Street 1:19 HILL ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2113
Practice Address - Country:US
Practice Address - Phone:845-294-9139
Practice Address - Fax:845-294-9139
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY393741OtherMVP HEALTH CARE
NY393741OtherMVP HEALTH CARE