Provider Demographics
NPI:1922076769
Name:STEVENS, LESLEY BETH (MA; LMHC)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:BETH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA; LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 220TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2354
Mailing Address - Country:US
Mailing Address - Phone:347-408-4124
Mailing Address - Fax:718-423-4250
Practice Address - Street 1:4020 220TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2354
Practice Address - Country:US
Practice Address - Phone:347-408-4124
Practice Address - Fax:718-423-4250
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00784-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health