Provider Demographics
NPI:1588818967
Name:STICKLER, LESLIE CHRISTINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:CHRISTINE
Last Name:STICKLER
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-3239
Mailing Address - Country:US
Mailing Address - Phone:505-325-0328
Mailing Address - Fax:505-327-7247
Practice Address - Street 1:1001 W BROADWAY
Practice Address - Street 2:STE. D
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-325-0328
Practice Address - Fax:505-327-7247
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-068331041C0700X
NMI-073301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61254339Medicaid