MEDICARE: SUSAN LESHEN 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	R046376-1	NY

General Provider Information

NPI Number	:	1528310281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LESHEN LCSW

Provider Business Mailing Address
First Line	:	207 SAINT JOHNS PL
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-2422
Country	:	US
Telephone Number	:	646-220-9714
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 SAINT JOHNS PL
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-2422
Country	:	US
Telephone Number	:	646-220-9714
Fax Number	:

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

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	09/23/2020

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