Provider Demographics
NPI:1760560643
Name:SANDLER, LESLIE N (EDD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:N
Last Name:SANDLER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 DRAYMORE CT
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9018
Mailing Address - Country:US
Mailing Address - Phone:717-583-1717
Mailing Address - Fax:717-583-1770
Practice Address - Street 1:1171 DRAYMORE CT
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9018
Practice Address - Country:US
Practice Address - Phone:717-583-1717
Practice Address - Fax:717-583-1770
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002303L103G00000X, 103TC0700X
PAPA002303L103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA29532OtherHIGHMARK BLUE SHIELD
PA50047945OtherPA CAPITAL BLUE CROSS
PA29532OtherINDEPENDENCE BLUE CROSS