Healthcare Provider Details

I. General information

NPI: 1851253637
Provider Name (Legal Business Name): LESLIE ANN HARTNETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N EAST EXPY NE
BROOKHAVEN GA
30329-2317
US

IV. Provider business mailing address

1209 OAKFIELD DR SE
ATLANTA GA
30316-3825
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-3689
  • Fax:
Mailing address:
  • Phone: 404-375-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005632
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: