Provider Demographics
NPI:1659648574
Name:DEBLASIO, LESLIE MARIANNE (MA, LPC, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIANNE
Last Name:DEBLASIO
Suffix:
Gender:F
Credentials:MA, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SICOMAC ROAD
Mailing Address - Street 2:P.O. BOX 162
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508
Mailing Address - Country:US
Mailing Address - Phone:973-495-6637
Mailing Address - Fax:
Practice Address - Street 1:18 SYCAMORE AVE STE 2
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1500
Practice Address - Country:US
Practice Address - Phone:201-540-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00181600101YA0400X
NJ37PC00568700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)