Provider Demographics
NPI:1083803753
Name:MINICH, LESLEY EVELYN (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:EVELYN
Last Name:MINICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:E
Other - Last Name:MINICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:199 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1835
Mailing Address - Country:US
Mailing Address - Phone:860-310-9344
Mailing Address - Fax:
Practice Address - Street 1:199 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-310-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0072661041C0700X
CALCSW619141041C0700X
CT0072661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical