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NPI Code Detail

MEDICARE: LESLIE DOMINIQUE BARROSO LCSW

MEDICARE: LESLIE DOMINIQUE BARROSO 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
1104100000XSocial Worker6801106770MI
2104100000XSocial WorkerLC23056ME

General Provider Information

NPI Number : 1821590316
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE DOMINIQUE BARROSO LCSW
Provider Business Mailing Address
First Line : 25 MILL BROOK RD
Second Line :
City : BAR HARBOR
State : ME
Zip : 04609-7352
Country : US
Telephone Number : 207-460-7020
Fax Number :
Provider Business Practice Location Address
First Line : 114 N MAIN ST STE 11
Second Line :
City : CHELSEA
State : MI
Zip : 48118-1514
Country : US
Telephone Number : 734-531-9490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2018
Last Update Date : 11/21/2024

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Directions to “ LESLIE DOMINIQUE BARROSO LCSW” Practice Location

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