Provider Demographics
NPI:1093303281
Name:DOCTOR, LESLIE ROBIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ROBIN
Last Name:DOCTOR
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 1:13805 WILD TURKEY PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3336
Mailing Address - Country:US
Mailing Address - Phone:512-507-6574
Mailing Address - Fax:
Practice Address - Street 1:607 RANCH ROAD 620 N
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-3912
Practice Address - Country:US
Practice Address - Phone:512-657-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical