MEDICARE: MR. LESLIE ALLAN COATES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW4945	FL

General Provider Information

NPI Number	:	1073700290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LESLIE ALLAN COATES LCSW

Provider Business Mailing Address
First Line	:	600 SANDTREE DR STE 202D
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1538
Country	:	US
Telephone Number	:	561-252-6907
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SANDTREE DR STE 202D
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1538
Country	:	US
Telephone Number	:	561-252-6907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	06/18/2019

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