Provider Demographics
NPI:1689656688
Name:LESHINE, PAULA LOU (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:LOU
Last Name:LESHINE
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 1:1575 BOSTON POST RD
Mailing Address - Street 2:SUITE C9
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2319
Mailing Address - Country:US
Mailing Address - Phone:203-458-0827
Mailing Address - Fax:203-488-6573
Practice Address - Street 1:1575 BOSTON POST RD
Practice Address - Street 2:SUITE C9
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2319
Practice Address - Country:US
Practice Address - Phone:203-458-0827
Practice Address - Fax:203-488-6573
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1709103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680000338Medicare ID - Type Unspecified