Healthcare Provider Details

I. General information

NPI: 1831427632
Provider Name (Legal Business Name): LESLIE ANN DELISLE APRN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CHRISTY DR
BROCKTON MA
02301-1839
US

IV. Provider business mailing address

600 MAIN ST
HANOVER MA
02339-1571
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-4611
  • Fax:
Mailing address:
  • Phone: 617-538-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number250699
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: