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NPI Code Detail

MEDICARE: CONSTANCE W LESLIE LICSW

MEDICARE: CONSTANCE W LESLIE 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
11041C0700XClinical Social Worker1018753MA

General Provider Information

NPI Number : 1316003460
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSTANCE W LESLIE LICSW
Provider Business Mailing Address
First Line : 16 ARMORY ST
Second Line :
City : NORTHAMPTON
State : MA
Zip : 01060-3857
Country : US
Telephone Number : 413-582-6922
Fax Number : 413-585-0525
Provider Business Practice Location Address
First Line : 16 ARMORY ST
Second Line :
City : NORTHAMPTON
State : MA
Zip : 01060-3857
Country : US
Telephone Number : 413-582-6922
Fax Number : 413-585-0525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2006
Last Update Date : 07/08/2007

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Directions to “ CONSTANCE W LESLIE LICSW” Practice Location

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