Provider Demographics
NPI:1518142819
Name:PEREIRA, LESLIE MICHELE (PHD, MSW)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MICHELE
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CORRIEDALE LN
Mailing Address - Street 2:
Mailing Address - City:COTTEKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12419-5029
Mailing Address - Country:US
Mailing Address - Phone:917-533-3082
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:SUITE 323
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1762
Practice Address - Country:US
Practice Address - Phone:917-533-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR065845-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical