Provider Demographics
NPI:1780124909
Name:LESKO, KATHRYN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:LESKO
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 1:35 ELM ST
Mailing Address - Street 2:SUITE 1RB
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2023
Mailing Address - Country:US
Mailing Address - Phone:203-321-3756
Mailing Address - Fax:
Practice Address - Street 1:35 ELM ST
Practice Address - Street 2:SUITE 1RB
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2023
Practice Address - Country:US
Practice Address - Phone:203-321-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003536103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist