Provider Demographics
NPI:1871641548
Name:CONNOR, LESLIE KAREN (PHD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:KAREN
Last Name:CONNOR
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 1:1409 FOULK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2755
Mailing Address - Country:US
Mailing Address - Phone:302-477-0708
Mailing Address - Fax:302-477-0136
Practice Address - Street 1:1409 FOULK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2755
Practice Address - Country:US
Practice Address - Phone:302-477-0708
Practice Address - Fax:302-477-0136
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000314103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist