Provider Demographics
NPI:1841660123
Name:LESSELBAUM, ERIC A (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:LESSELBAUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PARKVIEW AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2953
Mailing Address - Country:US
Mailing Address - Phone:914-310-0750
Mailing Address - Fax:
Practice Address - Street 1:35 PARKVIEW AVE.
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2953
Practice Address - Country:US
Practice Address - Phone:914-310-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical