Active NPI
Leslie Risin, PH.D.
- Clinical Psychologist
- Jackson, OH
National Provider Identifier
1962598599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4453
- Practice address
- 731 E Main St
Unit 13
Jackson, OH 45640-2100 - Phone
- (740) 286-8789
- Fax
- (740) 286-8789
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4453 | OH | Primary |
Addresses
Primary practice location
731 E Main St
Unit 13
Jackson, OH 45640-2100
Mailing address
731 E Main St
Unit 13
Jackson, OH 45640-2100
Phone (740) 286-8789
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0904301 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040330000850 | OH | Practitioner - Clinical Psychologist | 8123010477 | Practice locations: Jackson, OH |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
731 E Main St
Jackson, OH 45640-2100
Phone (740) 286-8789
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4453 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351814400000",
"number": "1962598599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "731 E MAIN ST",
"address_2": "UNIT 13",
"city": "JACKSON",
"state": "OH",
"postal_code": "456402100",
"telephone_number": "740-286-8789",
"fax_number": "740-286-8789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "731 E MAIN ST",
"address_2": "UNIT 13",
"city": "JACKSON",
"state": "OH",
"postal_code": "456402100",
"telephone_number": "740-286-8789",
"fax_number": "740-286-8789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RISIN",
"first_name": "LESLIE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2012-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "4453",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0904301",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.