Provider Demographics
NPI:1114789278
Name:ROBLES, LEISH L (LPCA)
Entity Type:Individual
Prefix:MS
First Name:LEISH
Middle Name:L
Last Name:ROBLES
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:MS
Other - First Name:LEISH
Other - Middle Name:L
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA
Mailing Address - Street 1:255 PLEASANT ST APT 205
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-3315
Mailing Address - Country:US
Mailing Address - Phone:860-899-5157
Mailing Address - Fax:
Practice Address - Street 1:289 WINDHAM RD
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-3528
Practice Address - Country:US
Practice Address - Phone:860-899-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6387101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101Y00000XBehavioral Health & Social Service ProvidersCounselor