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General NPI Number Information
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NPI Number | 1194944686
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Entity Type | Individual
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Provider Name | LESLIE BLAIR SERENA LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1925 S PERIMETER RD STE 120
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-7123
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Country | US
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Telephone | 954-958-0988
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Fax | 954-958-3527
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Provider Business Mailing Address
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Address Line | 10378 185TH ST S
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City | BOCA RATON
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State | FL
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Zip | 33498-6318
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Country | US
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Telephone | 561-488-7755
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Fax | 954-958-3527
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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 | SW7736
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License Number State | FL
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