Provider Demographics
NPI:1790921476
Name:LESER, EDWARD JACK
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JACK
Last Name:LESER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 STRAWBERRY BANK RD
Mailing Address - Street 2:APT 14
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-2763
Mailing Address - Country:US
Mailing Address - Phone:603-891-0119
Mailing Address - Fax:
Practice Address - Street 1:8 STRAWBERRY BANK RD
Practice Address - Street 2:APT 14
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2763
Practice Address - Country:US
Practice Address - Phone:603-891-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health