Provider Demographics
NPI:1265690820
Name:TUDOR, LESLIE ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ELIZABETH
Last Name:TUDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ELIZABETH
Other - Last Name:KASDAGLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:25 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-3124
Mailing Address - Country:US
Mailing Address - Phone:508-971-7861
Mailing Address - Fax:
Practice Address - Street 1:25 RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:WEST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585-3124
Practice Address - Country:US
Practice Address - Phone:508-971-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist