Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1083840193 |
---|---|
Provider Name | Dr. Leslie Davis Byron |
First Address | Ithaca, NY 14850-3342 |
Second Address | Ithaca, NY 14850-3342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2009 |
Last Update Date | 03/06/2009 |