Provider Demographics
NPI:1376534933
Name:LESHINSKY, ILENE B (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:B
Last Name:LESHINSKY
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 AMPERSAND DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6500
Mailing Address - Country:US
Mailing Address - Phone:518-566-0100
Mailing Address - Fax:518-566-0168
Practice Address - Street 1:18 AMPERSAND DR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6500
Practice Address - Country:US
Practice Address - Phone:518-566-0100
Practice Address - Fax:518-566-0168
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
S60743Medicare UPIN