Provider Demographics
NPI:1073667036
Name:BAER, LESLIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:BAER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TOWNSQUARE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2533
Mailing Address - Country:US
Mailing Address - Phone:973-635-5535
Mailing Address - Fax:908-508-0905
Practice Address - Street 1:5 TOWNSQUARE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2533
Practice Address - Country:US
Practice Address - Phone:973-635-5535
Practice Address - Fax:908-508-0905
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC066371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2651166OtherOXFORD ID #
NJ2219520OtherMHN ID #
NJ2819234OtherAETNA ID #
NJ021097OtherANHEUSER-BUSCH ID #
NJ523642Medicare ID - Type UnspecifiedMEDICARE ID #