Provider Demographics
NPI:1326738329
Name:BROWN, LESLIE KENYETTA (BEHAVIOR THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:KENYETTA
Last Name:BROWN
Suffix:
Gender:F
Credentials:BEHAVIOR THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FARLEY AVE # 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-1509
Mailing Address - Country:US
Mailing Address - Phone:862-218-8254
Mailing Address - Fax:
Practice Address - Street 1:22 FARLEY AVE # 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1509
Practice Address - Country:US
Practice Address - Phone:862-218-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty