Provider Demographics
NPI:1326293655
Name:DIFFER, LESLEE RAYE (LICSW)
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:RAYE
Last Name:DIFFER
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 1:399 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1218
Mailing Address - Country:US
Mailing Address - Phone:508-668-7703
Mailing Address - Fax:508-660-9639
Practice Address - Street 1:399 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1218
Practice Address - Country:US
Practice Address - Phone:508-668-7703
Practice Address - Fax:508-660-9639
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1183541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical