Individual provider Active NPI

Leah Marion Desole, PH.D.

  • Psychologist
  • New York, NY
National Provider Identifier
1104859636
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
015880 Issued in NY
Practice address
528 W 111TH St
Suite 27
New York, NY 10025-1977
Phone
(917) 757-5422
NPI assigned
Jul 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 015880 NY Primary

Addresses

Primary practice location

528 W 111TH St
Suite 27
New York, NY 10025-1977

Mailing address

528 W 111TH St
Suite 27
New York, NY 10025-1977
Phone (917) 757-5422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230911003811 NY Practitioner - Clinical Psychologist 5991169898 Practice locations: New York, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

590 W End Ave
Apt 5F
New York, NY 10024-1748
Phone (917) 757-5422

590 W End Ave Apt
5F
New York, NY 10024-1748

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104859636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 W 111TH ST",
            "address_2": "SUITE 27",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100251977",
            "telephone_number": "917-757-5422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 W 111TH ST",
            "address_2": "SUITE 27",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100251977",
            "telephone_number": "917-757-5422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESOLE",
        "first_name": "LEAH",
        "middle_name": "MARION",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "015880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.