Provider Demographics
NPI:1760510564
Name:MELTZER, LESLIE MARILYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MARILYN
Last Name:MELTZER
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 1:2106 NEW RD STE C1
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1049
Mailing Address - Country:US
Mailing Address - Phone:609-653-6202
Mailing Address - Fax:609-926-8389
Practice Address - Street 1:2106 NEW RD STE C1
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1049
Practice Address - Country:US
Practice Address - Phone:609-653-6202
Practice Address - Fax:609-926-8389
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
412714Medicare UPIN
ME412714Medicare ID - Type Unspecified