Provider Demographics
NPI:1114468097
Name:LESLIE, SARA HOGAN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:HOGAN
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9502
Mailing Address - Country:US
Mailing Address - Phone:724-728-8220
Mailing Address - Fax:724-728-2153
Practice Address - Street 1:697 STATE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9502
Practice Address - Country:US
Practice Address - Phone:724-728-8220
Practice Address - Fax:724-728-2153
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)