Provider Demographics
NPI:1578926978
Name:LSW PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:LSW PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:239-599-5656
Mailing Address - Street 1:8359 BEACON BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3066
Mailing Address - Country:US
Mailing Address - Phone:239-599-5656
Mailing Address - Fax:239-599-5655
Practice Address - Street 1:8359 BEACON BLVD STE 503
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3066
Practice Address - Country:US
Practice Address - Phone:239-599-5656
Practice Address - Fax:239-599-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty