Provider Demographics
NPI:1306938824
Name:VERTER, LESLIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:VERTER
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 1:300 W 109TH ST
Mailing Address - Street 2:APT. 6G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2100
Mailing Address - Country:US
Mailing Address - Phone:212-864-2992
Mailing Address - Fax:718-234-2314
Practice Address - Street 1:20 W 86TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3604
Practice Address - Country:US
Practice Address - Phone:646-229-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009260-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV7B261Medicare UPIN