Provider Demographics
NPI:1124594940
Name:STRACHAN, LESLIE PARKER (LICSW, LADC I)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:PARKER
Last Name:STRACHAN
Suffix:
Gender:F
Credentials:LICSW, LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1926
Mailing Address - Country:US
Mailing Address - Phone:617-733-5924
Mailing Address - Fax:
Practice Address - Street 1:127 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3533
Practice Address - Country:US
Practice Address - Phone:617-733-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical