MEDICARE: LESLIE ANN DEALY LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	104875	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104875	OTHER	MA	STATE LICENCE
2	ISW 00592	OTHER	RI	STATE LICENSE

General Provider Information

NPI Number	:	1023166287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ANN DEALY LICSW

Provider Business Mailing Address
First Line	:	95 COLONIAL WAY
Second Line	:
City	:	NORTH ATTLEBORO
State	:	MA
Zip	:	02760-2833
Country	:	US
Telephone Number	:	508-695-2770
Fax Number	:	508-695-2770

Provider Business Practice Location Address
First Line	:	95 COLONIAL WAY
Second Line	:
City	:	NORTH ATTLEBORO
State	:	MA
Zip	:	02760-2833
Country	:	US
Telephone Number	:	508-695-2770
Fax Number	:	508-695-2770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/09/2007

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Directions to “ LESLIE ANN DEALY LICSW” Practice Location

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