Provider Demographics
NPI:1649263765
Name:JACK J. LESYK, PH.D., INC.
Entity type:Organization
Organization Name:JACK J. LESYK, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LESYK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-575-6175
Mailing Address - Street 1:21625 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5363
Mailing Address - Country:US
Mailing Address - Phone:216-575-6175
Mailing Address - Fax:216-490-0155
Practice Address - Street 1:21625 CHAGRIN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5363
Practice Address - Country:US
Practice Address - Phone:216-575-6175
Practice Address - Fax:216-490-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty