Provider Demographics
NPI:1023166287
Name:DEALY, LESLIE ANN (LICSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:DEALY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 COLONIAL WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2833
Mailing Address - Country:US
Mailing Address - Phone:508-695-2770
Mailing Address - Fax:508-695-2770
Practice Address - Street 1:95 COLONIAL WAY
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-2833
Practice Address - Country:US
Practice Address - Phone:508-695-2770
Practice Address - Fax:508-695-2770
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1048751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA104875OtherSTATE LICENCE
RIISW 00592OtherSTATE LICENSE
RI30686-9Medicare UPIN
MA104875OtherSTATE LICENCE
RI1022980Medicare UPIN
RI400616Medicare UPIN
266074Medicare UPIN
62-51669Medicare UPIN
005837Medicare UPIN
7600191Medicare UPIN
RI04312912603Medicare UPIN
MAPO3016Medicare UPIN