Provider Demographics
NPI:1942585955
Name:SZEMPRUCH, LESLIE JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JOSEPH
Last Name:SZEMPRUCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:SZEMPRUCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:101 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5717
Mailing Address - Country:US
Mailing Address - Phone:315-339-0110
Mailing Address - Fax:
Practice Address - Street 1:101 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5717
Practice Address - Country:US
Practice Address - Phone:315-339-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007134103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist