Provider Demographics
NPI:1598783474
Name:HOLBROOK, LESLIE JEAN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:JEAN
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PANTHER LN
Mailing Address - Street 2:SUITE 351
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7874
Mailing Address - Country:US
Mailing Address - Phone:239-961-3366
Mailing Address - Fax:239-591-6601
Practice Address - Street 1:1415 PANTHER LN
Practice Address - Street 2:SUITE 351
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7874
Practice Address - Country:US
Practice Address - Phone:239-961-3366
Practice Address - Fax:239-591-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 69951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ026ROtherB/C B/S
FLZ026ROtherB/C B/S
FLZ026ROtherB/C B/S