Healthcare Provider Details

I. General information

NPI: 1205296134
Provider Name (Legal Business Name): LESLIE SZASZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 W ELDER ST STE 208
BOISE ID
83705-4772
US

IV. Provider business mailing address

1614 N 17TH ST
BOISE ID
83702-1001
US

V. Phone/Fax

Practice location:
  • Phone: 614-307-6698
  • Fax:
Mailing address:
  • Phone: 614-323-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1302240
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-41119
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700189
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: