Provider Demographics
NPI:1235851783
Name:OWENS, LESLIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ELIZABETH
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BRAINEY ST
Mailing Address - Street 2:
Mailing Address - City:LAURENCE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2603
Mailing Address - Country:US
Mailing Address - Phone:862-279-3341
Mailing Address - Fax:
Practice Address - Street 1:333 BRAINEY ST
Practice Address - Street 2:
Practice Address - City:LAURENCE HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08879-2603
Practice Address - Country:US
Practice Address - Phone:862-279-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00637900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional