Provider Demographics
NPI:1316003460
Name:LESLIE, CONSTANCE W (LICSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:W
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ARMORY ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3857
Mailing Address - Country:US
Mailing Address - Phone:413-582-6922
Mailing Address - Fax:413-585-0525
Practice Address - Street 1:16 ARMORY ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3857
Practice Address - Country:US
Practice Address - Phone:413-582-6922
Practice Address - Fax:413-585-0525
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10187531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical