Provider Demographics
NPI:1447751052
Name:LESIEUR, CHRISTOPHER M
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:LESIEUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 DIXWELL AVE.
Mailing Address - Street 2:PO BOX 4098
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514
Mailing Address - Country:US
Mailing Address - Phone:203-314-7163
Mailing Address - Fax:
Practice Address - Street 1:30 HAZEL TER
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2240
Practice Address - Country:US
Practice Address - Phone:203-819-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health