Provider Demographics
NPI:1720195118
Name:MATILAINEN, LESLIE KIM (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:KIM
Last Name:MATILAINEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:MILLERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01349-1317
Mailing Address - Country:US
Mailing Address - Phone:508-451-2403
Mailing Address - Fax:
Practice Address - Street 1:100 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1804
Practice Address - Country:US
Practice Address - Phone:978-466-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health