Provider Demographics
NPI:1215221270
Name:SANFILIPPO, LESLEY (LSW)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 BOARDWALK DR
Mailing Address - Street 2:UNIT 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5945
Mailing Address - Country:US
Mailing Address - Phone:732-842-2000
Mailing Address - Fax:732-212-2890
Practice Address - Street 1:270 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5920
Practice Address - Country:US
Practice Address - Phone:732-842-2000
Practice Address - Fax:732-212-2890
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099247651041C0700X
NJ44SL05694000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health