Provider Demographics
NPI:1568404432
Name:MARGESON, LESLIE BROWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:BROWN
Last Name:MARGESON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:NEWMAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 CITY HALL AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1985
Mailing Address - Country:US
Mailing Address - Phone:757-868-0072
Mailing Address - Fax:757-868-0087
Practice Address - Street 1:200 CITY HALL AVE
Practice Address - Street 2:SUITE E
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1985
Practice Address - Country:US
Practice Address - Phone:757-868-0072
Practice Address - Fax:757-868-0087
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008902992Medicaid
VA800001911Medicare ID - Type Unspecified