Provider Demographics
NPI:1851739247
Name:MEARS, LESLIE L
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:MEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CORPORATE DRIVE, SUITE 203
Mailing Address - Street 2:DYNAMIC CENTER, INC.
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917
Mailing Address - Country:US
Mailing Address - Phone:845-651-2245
Mailing Address - Fax:
Practice Address - Street 1:464 ROUTE 17A
Practice Address - Street 2:DYNAMIC CENTER, INC.
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921
Practice Address - Country:US
Practice Address - Phone:845-651-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator