Healthcare Provider Details

I. General information

NPI: 1669780037
Provider Name (Legal Business Name): LESLIE M. KAHN LCSW, PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 BROOKWOOD MEDICAL CTR DR SUITE 310
BIRMINGHAM AL
35209-6898
US

IV. Provider business mailing address

PO BOX 43933
BIRMINGHAM AL
35243-0933
US

V. Phone/Fax

Practice location:
  • Phone: 205-329-7815
  • Fax: 205-329-7816
Mailing address:
  • Phone: 205-821-9758
  • Fax: 205-876-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1652C, PIP
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: