Provider Demographics
NPI:1649303553
Name:WILLIAMS, LESLIE JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JOHN
Last Name:WILLIAMS
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 1:55 MORRIS AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1426
Mailing Address - Country:US
Mailing Address - Phone:973-218-0555
Mailing Address - Fax:973-218-9595
Practice Address - Street 1:55 MORRIS AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1426
Practice Address - Country:US
Practice Address - Phone:973-218-0555
Practice Address - Fax:973-218-9595
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI002551103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist