Healthcare Provider Details

I. General information

NPI: 1891124301
Provider Name (Legal Business Name): LESLIE FACTOR MSW, LCSW, CAC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 S VINE ST STE 215
CENTENNIAL CO
80121-2735
US

IV. Provider business mailing address

12 BROOKHAVEN TRL
LITTLETON CO
80123-6687
US

V. Phone/Fax

Practice location:
  • Phone: 303-902-3519
  • Fax:
Mailing address:
  • Phone: 303-902-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989716
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: