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General NPI Number Information
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NPI Number | 1437501178
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Entity Type | Organization
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Legal Business Name | LESLIE MARSHALL LLC
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 2335 BLACK ROCK TPKE
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City | FAIRFIELD
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State | CT
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Zip | 06825-3220
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Country | US
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Telephone | 203-984-6456
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Fax |
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Provider Business Mailing Address
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Address Line | 164 FARIST RD
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City | FAIRFIELD
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State | CT
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Zip | 06825-3207
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Country | US
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Telephone | 203-984-6456
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Fax |
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Authorized Official
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Title or Position | LMFT
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Name | LESLIE MARSHALL
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Credential | LMFT
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Telephone | 203-984-6456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1795
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License Number State | CT
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