Provider Demographics
NPI:1043209539
Name:GILBERT, LESLIE RUTH (PHD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:RUTH
Last Name:GILBERT
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 1:2025 HAMBURG TPKE
Mailing Address - Street 2:STE B
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6260
Mailing Address - Country:US
Mailing Address - Phone:973-616-1566
Mailing Address - Fax:973-616-1566
Practice Address - Street 1:2025 HAMBURG TPKE
Practice Address - Street 2:STE B
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6260
Practice Address - Country:US
Practice Address - Phone:973-616-1566
Practice Address - Fax:973-616-1566
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGI447844Medicare ID - Type Unspecified