Provider Demographics
NPI:1093915019
Name:CHYTEN, LESLIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:CHYTEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 WABAN PARK
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1409
Mailing Address - Country:US
Mailing Address - Phone:617-969-8446
Mailing Address - Fax:
Practice Address - Street 1:88 WABAN PARK
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1409
Practice Address - Country:US
Practice Address - Phone:617-969-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1045351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO2691Medicare PIN