Provider Demographics
NPI:1952809956
Name:FOGELSON, LEEANN (PHD)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:FOGELSON
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 1:41 MADISON AVE STE 2541
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2202
Mailing Address - Country:US
Mailing Address - Phone:646-202-2612
Mailing Address - Fax:646-349-9614
Practice Address - Street 1:41 MADISON AVE STE 2541
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2202
Practice Address - Country:US
Practice Address - Phone:646-202-2612
Practice Address - Fax:646-349-9614
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent