Provider Demographics
NPI:1619098589
Name:TEBO, LESLIE (LMSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:TEBO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:SCIOLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:244 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3404
Mailing Address - Country:US
Mailing Address - Phone:716-831-7877
Mailing Address - Fax:716-831-6666
Practice Address - Street 1:244 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3404
Practice Address - Country:US
Practice Address - Phone:716-831-7877
Practice Address - Fax:716-831-6666
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085833-1104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator