Active NPI
Leslie Weidenman, PH.D
- Cognitive & Behavioral Psychologist
- Providence, RI
National Provider Identifier
1104955061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- PS00269
- Practice address
- 86 Mount Hope Ave
Providence, RI 02906-1648 - Phone
- (401) 274-6310
- Fax
- (401) 421-3280
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS00269 | RI | |
| Cognitive & Behavioral Psychologist | 103TB0200X | PS00269 | RI | Primary |
Addresses
Primary practice location
86 Mount Hope Ave
Providence, RI 02906-1648
Mailing address
40 Stenton Ave
Apt 312
Providence, RI 02906-2741
Phone (401) 274-6310
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LW23739 | Medicaid | RI | |
| 30890-2 | Other | RI | BLUE CROSS |
| 412380 | Other | RI | BLUE CHIP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS00269 | RI | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1104955061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 STENTON AVE",
"address_2": "APT 312",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029062741",
"telephone_number": "401-274-6310",
"fax_number": "401-421-3280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "86 MOUNT HOPE AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029061648",
"telephone_number": "401-274-6310",
"fax_number": "401-421-3280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEIDENMAN",
"first_name": "LESLIE",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "RI",
"license": "PS00269",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "RI",
"license": "PS00269",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LW23739",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "30890-2",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP",
"identifier": "412380",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.