Provider Demographics
NPI:1861929895
Name:MONGELLUZZI, LESLIE CUVA (IMFT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:CUVA
Last Name:MONGELLUZZI
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5821
Mailing Address - Country:US
Mailing Address - Phone:949-939-5144
Mailing Address - Fax:216-274-9912
Practice Address - Street 1:8565 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5821
Practice Address - Country:US
Practice Address - Phone:440-320-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1700011103TP2701X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy