MEDICARE: LESLEY MCDONALD LCSW

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	44SL05809900	NJ

General Provider Information

NPI Number	:	1821408956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY MCDONALD LCSW

Provider Business Mailing Address
First Line	:	22 LINCOLN AVE
Second Line	:
City	:	TOTOWA
State	:	NJ
Zip	:	07512-2736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 SHORT HILLS CIR
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1233
Country	:	US
Telephone Number	:	973-896-0449
Fax Number	:

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

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	03/13/2023

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