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General NPI Number Information
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NPI Number | 1942530902
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Entity Type | Individual
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Provider Name | LESLIE R. SHIELDS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 43 BERRY HILL RD
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City | OYSTER BAY
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State | NY
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Zip | 11771-3516
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Country | US
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Telephone | 516-624-0512
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Fax | 516-624-0512
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Provider Business Mailing Address
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Address Line | 288 FILLOW ST
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City | NORWALK
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State | CT
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Zip | 06850-2214
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Country | US
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Telephone | 516-318-3758
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R030570-1
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License Number State | NY
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