Provider Demographics
NPI:1891872297
Name:TEPPER, LESLEY D (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:D
Last Name:TEPPER
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 1:333 E 56TH ST
Mailing Address - Street 2:#17J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3758
Mailing Address - Country:US
Mailing Address - Phone:212-758-4104
Mailing Address - Fax:212-758-4104
Practice Address - Street 1:333 E 56TH ST
Practice Address - Street 2:#17J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3758
Practice Address - Country:US
Practice Address - Phone:212-758-4104
Practice Address - Fax:212-758-4104
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03562511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNLV502Medicare ID - Type Unspecified