Individual provider Active NPI

Leslie F Dimella, PSYD

  • Clinical Psychologist
  • New Haven, CT
National Provider Identifier
1346226222
Registry record updated May 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
003109 Issued in CT
Practice address
374 Grand Ave
Fair Haven Community Health Center
New Haven, CT 06513-3733
Phone
(203) 777-7411
NPI assigned
Dec 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 003109 CT Primary

Addresses

Primary practice location

374 Grand Ave
Fair Haven Community Health Center
New Haven, CT 06513-3733

Mailing address

210 Millbrook Rd
North Haven, CT 06473-4336
Phone (203) 507-2036

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150326000062 CT Practitioner - Psychiatry 2668447996 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fair Haven Community Health Clinic IncGroup PAC ID 4183511538, 45 clinicians

Practice addresses (Care Compare)

100 James St
New Haven, CT 06513-4222
Phone (203) 777-7411

164 Grand Ave
New Haven, CT 06513-3938
Phone (203) 777-7411

293 Clinton Ave
New Haven, CT 06513-2814
Phone (203) 777-7411

339 Eastern St
BLDG B
New Haven, CT 06513-2463
Phone (203) 777-7411

35 Wheelbarrow LN
East Haven, CT 06513-2003
Phone (203) 777-7411

374 Grand Ave
New Haven, CT 06513-3733
Phone (203) 777-7411

374 Grand Ave
New Haven, CT 06513-3787

50 Grand Ave
New Haven, CT 06513-3949
Phone (203) 777-7411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
003109CTMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fair Haven Community Health Clinic Inc CurrentSince Feb 25, 2015 Accepting new patients
Fair Haven Community Health Clinic, Inc CurrentSince Feb 25, 2015 Accepting new patients

Locations

374 Grand Ave
New Haven, CT 06513
Phone (203) 752-5203

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367798400000",
    "number": "1346226222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 MILLBROOK RD",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064734336",
            "telephone_number": "203-507-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 GRAND AVE",
            "address_2": "FAIR HAVEN COMMUNITY HEALTH CENTER",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133733",
            "telephone_number": "203-777-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMELLA",
        "first_name": "LESLIE",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2013-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "003109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.