Provider Demographics
NPI:1851563803
Name:CARY, LESLIE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:CARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2671 CYPRESS HEAD TRAIL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-402-2203
Mailing Address - Fax:
Practice Address - Street 1:111 W MAGNOLIA AVENUE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750
Practice Address - Country:US
Practice Address - Phone:407-215-0095
Practice Address - Fax:407-261-0523
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 474106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001742900Medicaid