Healthcare Provider Details

I. General information

NPI: 1568227304
Provider Name (Legal Business Name): ALISON FEDORIS LESLIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W HILLCREST AVE
HAVERTOWN PA
19083-1130
US

IV. Provider business mailing address

407 FAIRVIEW RD
PENN VALLEY PA
19072-1411
US

V. Phone/Fax

Practice location:
  • Phone: 610-850-2434
  • Fax:
Mailing address:
  • Phone: 610-850-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024583
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: