Provider Demographics
NPI:1760726939
Name:LESHON, LAWRENCE J (LSW)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:LESHON
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 DRESSLER RD NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2543
Mailing Address - Country:US
Mailing Address - Phone:330-493-0083
Mailing Address - Fax:330-493-3689
Practice Address - Street 1:4895 DRESSLER RD NW
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2543
Practice Address - Country:US
Practice Address - Phone:330-493-0083
Practice Address - Fax:330-493-3689
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0020518104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864191Medicaid