Healthcare Provider Details

I. General information

NPI: 1700906112
Provider Name (Legal Business Name): LESLEY KUCHEK LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N PORTLAND AVE CUMBERLAND DIAGNOSTIC AND TREATMENT CENTER
BROOKLYN NY
11205-2005
US

IV. Provider business mailing address

310 94TH ST APT 415
BROOKLYN NY
11209-6941
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-7832
  • Fax:
Mailing address:
  • Phone: 718-260-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR054166-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: