Provider Demographics
NPI:1588912612
Name:PACKER, LESLIE E (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:PACKER
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 1:940 LINCOLN PL
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1016
Mailing Address - Country:US
Mailing Address - Phone:516-785-2653
Mailing Address - Fax:516-409-4248
Practice Address - Street 1:940 LINCOLN PL
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1016
Practice Address - Country:US
Practice Address - Phone:516-785-2653
Practice Address - Fax:516-409-4248
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008829103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist