Provider Demographics
NPI:1457689911
Name:KRIEGER, LESLIE HERBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:HERBERT
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 REEDPOND DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-4820
Mailing Address - Country:US
Mailing Address - Phone:904-268-3773
Mailing Address - Fax:904-268-8288
Practice Address - Street 1:3834 REEDPOND DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-4820
Practice Address - Country:US
Practice Address - Phone:904-268-3773
Practice Address - Fax:904-268-8288
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist