Provider Demographics
NPI:1952855959
Name:NEWPORT, LESLIE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:NEWPORT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1738
Mailing Address - Country:US
Mailing Address - Phone:732-524-8600
Mailing Address - Fax:646-583-8600
Practice Address - Street 1:85 RARITAN AVE STE 420
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2439
Practice Address - Country:US
Practice Address - Phone:732-524-8600
Practice Address - Fax:646-583-8600
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-13764103K00000X
NJ35SI00305600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst