Individual
LELAND W PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CP
Contact information
Practice address
11 BEECHWOOD DR, GLEN HEAD, NY 11545-1101
(516) 671-7509
Mailing address
11 BEECHWOOD DR, GLEN HEAD, NY 11545-1101
(516) 671-7509
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
05430
NY
Other
Enumeration date
04/19/2007
Last updated
10/31/2007
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