Provider Demographics
NPI:1477093276
Name:HAAS, LESLEY (MA, EDS, LAC)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:MA, EDS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WILLIAM LIVINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7630
Mailing Address - Country:US
Mailing Address - Phone:609-658-5391
Mailing Address - Fax:
Practice Address - Street 1:165 THIRD ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1800
Practice Address - Country:US
Practice Address - Phone:609-836-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00296400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional