MEDICARE: LESLIE REBECCA CONNELL 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	CSW.09930492	CO
2	1041C0700X	Clinical Social Worker	LCS19814	CA

General Provider Information

NPI Number	:	1346301181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE REBECCA CONNELL LCSW

Provider Business Mailing Address
First Line	:	5845 COLLEGE AVE STE 8
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-1635
Country	:	US
Telephone Number	:	510-594-8224
Fax Number	:

Provider Business Practice Location Address
First Line	:	5845 COLLEGE AVE STE 8
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-1635
Country	:	US
Telephone Number	:	510-594-8224
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	02/26/2025

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