Provider Demographics
NPI:1568462067
Name:SHARP, LESLIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 ELBERTA CIR
Mailing Address - Street 2:# 189
Mailing Address - City:PARK HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3817
Mailing Address - Country:US
Mailing Address - Phone:859-491-7421
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3408
Practice Address - Country:US
Practice Address - Phone:859-578-5900
Practice Address - Fax:859-578-5940
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY06221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP40904Medicare UPIN
KY0687702Medicare ID - Type Unspecified