Provider Demographics
NPI:1750852786
Name:SAGALOW, LESLEY PAIGE (MED, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:PAIGE
Last Name:SAGALOW
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 OLD YORK RD # 12
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1522
Mailing Address - Country:US
Mailing Address - Phone:610-716-8290
Mailing Address - Fax:
Practice Address - Street 1:226 W RITTENHOUSE SQ APT 2113
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5752
Practice Address - Country:US
Practice Address - Phone:610-716-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty