Provider Demographics
NPI:1609933647
Name:KUBISIAK, LESLIE GAYLE (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:GAYLE
Last Name:KUBISIAK
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6268
Mailing Address - Country:US
Mailing Address - Phone:908-755-3055
Mailing Address - Fax:908-755-3155
Practice Address - Street 1:786 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6268
Practice Address - Country:US
Practice Address - Phone:908-755-3055
Practice Address - Fax:908-755-3155
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00310900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional