Provider Demographics
NPI:1942530902
Name:SHIELDS, LESLIE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:R
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:288 FILLOW ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-2214
Mailing Address - Country:US
Mailing Address - Phone:516-318-3758
Mailing Address - Fax:
Practice Address - Street 1:43 BERRY HILL RD
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-3516
Practice Address - Country:US
Practice Address - Phone:516-624-0512
Practice Address - Fax:516-624-0512
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NYR030570-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health