Provider Demographics
NPI:1558495473
Name:HOWARD-MCINTYRE, LESLIE CLAIRE (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CLAIRE
Last Name:HOWARD-MCINTYRE
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUMMER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1175
Mailing Address - Country:US
Mailing Address - Phone:802-728-3433
Mailing Address - Fax:
Practice Address - Street 1:4 SUMMER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1175
Practice Address - Country:US
Practice Address - Phone:802-728-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010047Medicaid