Provider Demographics
NPI:1912333899
Name:HERNANDEZ MONTANEZ, LESLIE ANN (PSY D)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:HERNANDEZ MONTANEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB EL JARDIN CALLE 2A CASA B31
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-1719
Mailing Address - Country:US
Mailing Address - Phone:787-358-5633
Mailing Address - Fax:
Practice Address - Street 1:1519 AVE PONCE DE LEON STE 811
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1719
Practice Address - Country:US
Practice Address - Phone:787-358-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7007103TC0700X, 103TC0700X
PR13485104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical