Provider Demographics
NPI:1801978440
Name:JANSON, LESLIE (MA, LICENSED PSYCH)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:JANSON
Suffix:
Gender:F
Credentials:MA, LICENSED PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 PARK RD EXT
Mailing Address - Street 2:
Mailing Address - City:GOLDENS BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10526-1135
Mailing Address - Country:US
Mailing Address - Phone:914-391-6052
Mailing Address - Fax:
Practice Address - Street 1:66 MAIN ST
Practice Address - Street 2:C/O WESTCHESTER INSTITUTE
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-1800
Practice Address - Country:US
Practice Address - Phone:914-391-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000528-1103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis