Provider Demographics
NPI:1144979907
Name:BENSON, LESLYE (CLC, CLPC,SBT)
Entity type:Individual
Prefix:MS
First Name:LESLYE
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:CLC, CLPC,SBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NORTHERN BLVD STE 324-1417
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1000
Mailing Address - Country:US
Mailing Address - Phone:838-218-6642
Mailing Address - Fax:
Practice Address - Street 1:60 BENSON ST APT 1
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2133
Practice Address - Country:US
Practice Address - Phone:585-735-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172V00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker