Provider Demographics
NPI:1265087449
Name:DR. LESLIE GAVIN, PH.D. PLLC
Entity type:Organization
Organization Name:DR. LESLIE GAVIN, PH.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GAVIN DEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-701-4516
Mailing Address - Street 1:1515 S ORLANDO AVE STE M
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6471
Mailing Address - Country:US
Mailing Address - Phone:407-701-4516
Mailing Address - Fax:
Practice Address - Street 1:1515 S ORLANDO AVE STE M
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6471
Practice Address - Country:US
Practice Address - Phone:407-701-4516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty