Provider Demographics
NPI:1104281963
Name:LESLIE, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LESLIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 LOWER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938
Mailing Address - Country:US
Mailing Address - Phone:215-499-6561
Mailing Address - Fax:
Practice Address - Street 1:6247 LOWER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938
Practice Address - Country:US
Practice Address - Phone:215-499-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health