Provider Demographics
NPI:1891009411
Name:BOULETTE, LESLIE JEAN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JEAN
Last Name:BOULETTE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3727
Mailing Address - Country:US
Mailing Address - Phone:508-765-9101
Mailing Address - Fax:508-764-4389
Practice Address - Street 1:328 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-3727
Practice Address - Country:US
Practice Address - Phone:508-765-9101
Practice Address - Fax:508-764-4389
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health