Provider Demographics
NPI:1750342002
Name:MCGOVERN, LESLIE KATHRYN (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:KATHRYN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 KNARR RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-3518
Mailing Address - Country:US
Mailing Address - Phone:814-684-4164
Mailing Address - Fax:814-234-3572
Practice Address - Street 1:1001 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6600
Practice Address - Country:US
Practice Address - Phone:814-237-8361
Practice Address - Fax:814-234-3572
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-008327-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMC-885-068Medicare ID - Type UnspecifiedPSYCHOLOGIST