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General NPI Number Information
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NPI Number | 1194237602
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Entity Type | Individual
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Provider Name | LESLIE TUBUL LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 51 UPPER MONTCLAIR PLZ STE 25
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1340
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Country | US
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Telephone | 862-505-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 30 ELIZABETH ST
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City | CALDWELL
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State | NJ
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Zip | 07006-5606
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Country | US
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Telephone | 973-396-7900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05643600
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License Number State | NJ
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