Healthcare Provider Details

I. General information

NPI: 1356326144
Provider Name (Legal Business Name): LESLIE GISELLE FELSHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22A WHEELER RD
NORTH SALEM NY
10560-2802
US

IV. Provider business mailing address

22A WHEELER RD
NORTH SALEM NY
10560-2802
US

V. Phone/Fax

Practice location:
  • Phone: 917-403-6625
  • Fax:
Mailing address:
  • Phone: 917-403-6625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0261571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: