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General NPI Number Information
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NPI Number | 1699830497
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Entity Type | Individual
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Provider Name | LESLIE A. MCCONNELL LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 637 WASHINGTON ST
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City | DORCHESTER CENTER
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State | MA
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Zip | 02124-3510
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Country | US
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Telephone | 617-822-2811
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Fax |
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Provider Business Mailing Address
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Address Line | 770 CUMMINS HWY #24
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City | MATTAPAN
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State | MA
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Zip | 02126-1748
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 105530
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License Number State | MA
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