Provider Demographics
NPI:1619079985
Name:HAUN, LESLIE PAIGE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:PAIGE
Last Name:HAUN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAPLE ST UNIT 26
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3337
Mailing Address - Country:US
Mailing Address - Phone:860-713-3364
Mailing Address - Fax:
Practice Address - Street 1:27 HARTFORD TPKE STE 208K
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5245
Practice Address - Country:US
Practice Address - Phone:860-713-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000685CT03OtherBLUE CROSS, BLUE SHIELD
CT004181517Medicaid