Provider Demographics
NPI:1073724316
Name:RAWLINGS, LESLIE S (ACSW-R,LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:RAWLINGS
Suffix:
Gender:F
Credentials:ACSW-R,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 UPPER MONTCLAIR PLZ
Mailing Address - Street 2:ROOM 16
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1343
Mailing Address - Country:US
Mailing Address - Phone:973-509-1910
Mailing Address - Fax:
Practice Address - Street 1:51 UPPER MONTCLAIR PLZ
Practice Address - Street 2:ROOM 16
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1343
Practice Address - Country:US
Practice Address - Phone:973-509-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046323101Y00000X
NJ44SC051744001041C0700X
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ180566OtherMEDICARE ID
NJ180566OtherMEDICARE ID