Provider Demographics
NPI:1073700290
Name:COATES, LESLIE ALLAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:ALLAN
Last Name:COATES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SANDTREE DR STE 202D
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1538
Mailing Address - Country:US
Mailing Address - Phone:561-252-6907
Mailing Address - Fax:
Practice Address - Street 1:600 SANDTREE DR STE 202D
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1538
Practice Address - Country:US
Practice Address - Phone:561-252-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW49451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8248Medicare PIN