Provider Demographics
NPI:1245569425
Name:WEISS, LESLIE (LCSW, LADC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 SHORE RD
Mailing Address - Street 2:APT 1A
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4369
Mailing Address - Country:US
Mailing Address - Phone:207-286-6685
Mailing Address - Fax:
Practice Address - Street 1:345 SHORE RD
Practice Address - Street 2:APT 1A
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4369
Practice Address - Country:US
Practice Address - Phone:207-286-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4538101YA0400X
MELC68341041C0700X
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)