Provider Demographics
NPI:1952407017
Name:MACCARDELL, LESLIE HART (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:HART
Last Name:MACCARDELL
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 1:36 PLUMFIELD LN
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3823
Mailing Address - Country:US
Mailing Address - Phone:781-934-2597
Mailing Address - Fax:781-934-2597
Practice Address - Street 1:36 PLUMFIELD LN
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3823
Practice Address - Country:US
Practice Address - Phone:781-934-2597
Practice Address - Fax:781-934-2597
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1899287Medicaid
MAW50464Medicare ID - Type Unspecified