Provider Demographics
NPI:1740219328
Name:BURSLEY, LESLIE LEE (LICSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LEE
Last Name:BURSLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:LEE
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 OCEANWOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:N KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-295-5460
Mailing Address - Fax:401-667-2810
Practice Address - Street 1:277 WATERMAN STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-331-7777
Practice Address - Fax:401-354-4445
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411410OtherBLUE CHIP
RI270951OtherBLUE CROSS BLUE SHIELD