Provider Demographics
NPI:1114251857
Name:BROWN, LESLIE JAMES (CASAC-T)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:JAMES
Last Name:BROWN
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 ERICSSON ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1607
Mailing Address - Country:US
Mailing Address - Phone:347-848-4446
Mailing Address - Fax:347-617-1012
Practice Address - Street 1:2439 ERICSSON ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1607
Practice Address - Country:US
Practice Address - Phone:347-848-4446
Practice Address - Fax:347-617-1012
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-T 23862101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23862OtherCASAC-T