Provider Demographics
NPI:1962482455
Name:CLEMENT, LESLIE D (LISW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:D
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13645 LARCHMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1345
Mailing Address - Country:US
Mailing Address - Phone:216-921-1921
Mailing Address - Fax:216-932-3138
Practice Address - Street 1:13645 LARCHMERE BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-1345
Practice Address - Country:US
Practice Address - Phone:216-921-1921
Practice Address - Fax:216-932-3138
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00075511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical