Provider Demographics
NPI:1578655726
Name:CHIOTASSO, LESLIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:CHIOTASSO
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 1:20 FORD RD
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-3313
Mailing Address - Country:US
Mailing Address - Phone:781-340-9758
Mailing Address - Fax:617-479-0356
Practice Address - Street 1:94 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-1721
Practice Address - Country:US
Practice Address - Phone:781-331-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10228161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical