Provider Demographics
NPI:1467107805
Name:LESKO, MAE V (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:MAE
Middle Name:V
Last Name:LESKO
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 1:9005 RIVERSIDE PL FL 3
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6261
Mailing Address - Country:US
Mailing Address - Phone:201-682-1000
Mailing Address - Fax:
Practice Address - Street 1:354 MERRIMACK ST STE 395
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1755
Practice Address - Country:US
Practice Address - Phone:201-321-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSL06655400104100000X
LICSW1267121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker