Provider Demographics
NPI:1447240288
Name:LESSER, ADAM M (MSW)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:M
Last Name:LESSER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 JOEL CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1412
Mailing Address - Country:US
Mailing Address - Phone:617-285-0149
Mailing Address - Fax:815-572-0120
Practice Address - Street 1:5160 JOEL COURT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-1412
Practice Address - Country:US
Practice Address - Phone:617-285-0149
Practice Address - Fax:815-572-0120
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0040121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7799218OtherAETNA
MA010547OtherVALUE OPTIONS
MA361138OtherMHN
MA263860000OtherCMSP
MA361138OtherMHN