Provider Demographics
NPI:1568022531
Name:LESLIE, ASYA MONIQUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ASYA MONIQUE
Middle Name:
Last Name:LESLIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:A. MONIQUE
Other - Middle Name:
Other - Last Name:LESLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 11655
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-0655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5047 ROBERT J MATHEWS PKWY STE 302
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5748
Practice Address - Country:US
Practice Address - Phone:916-992-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0011259103T00000X, 103TC0700X, 103TF0200X
CA30961103TC0700X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic