Provider Demographics
NPI:1902945231
Name:LESANICS, DOREENA (PHD)
Entity type:Individual
Prefix:DR
First Name:DOREENA
Middle Name:
Last Name:LESANICS
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 1:75 CRYSTAL RUN RD STE 135
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7009
Mailing Address - Country:US
Mailing Address - Phone:845-333-7800
Mailing Address - Fax:
Practice Address - Street 1:75 CRYSTAL RUN RD STE 135
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7009
Practice Address - Country:US
Practice Address - Phone:845-333-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03331519Medicaid