Provider Demographics
NPI:1629574751
Name:SALAS, LESLIE JANET (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JANET
Last Name:SALAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:JANET
Other - Last Name:GONZAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:13028 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5770
Mailing Address - Country:US
Mailing Address - Phone:858-568-3457
Mailing Address - Fax:
Practice Address - Street 1:10815 RANCHO BERNARDO RD STE 380
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-5724
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1130131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program