Provider Demographics
NPI:1821590316
Name:BARROSO, LESLIE DOMINIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DOMINIQUE
Last Name:BARROSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3410
Mailing Address - Country:US
Mailing Address - Phone:207-460-7020
Mailing Address - Fax:
Practice Address - Street 1:114 N MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1514
Practice Address - Country:US
Practice Address - Phone:734-531-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC23056104100000X
MI6801106770104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker