Provider Demographics
NPI:1770780314
Name:SLESAR, CLARISSA RHIANNON (PHD)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:RHIANNON
Last Name:SLESAR
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 1:611 BROADWAY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2608
Mailing Address - Country:US
Mailing Address - Phone:347-581-1688
Mailing Address - Fax:212-777-3918
Practice Address - Street 1:611 BROADWAY
Practice Address - Street 2:SUITE 520
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2608
Practice Address - Country:US
Practice Address - Phone:347-581-1688
Practice Address - Fax:212-777-3918
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical