Provider Demographics
NPI:1497848758
Name:JOSEPH, LESLIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:JOSEPH
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 1:21 BRICKETT ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01985-2232
Mailing Address - Country:US
Mailing Address - Phone:978-462-3611
Mailing Address - Fax:978-462-6778
Practice Address - Street 1:441 MAIN ST
Practice Address - Street 2:SU. 205
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3859
Practice Address - Country:US
Practice Address - Phone:781-662-6060
Practice Address - Fax:978-462-6778
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1044991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA18431OtherVALUE OPTIONS
MAPO2554OtherBCBS
MA18431OtherVALUE OPTIONS