Provider Demographics
NPI:1295053619
Name:MARTIN, LESLEY AMY (LMHC)
Entity type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:AMY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4242 RIDGE LEA RD
Practice Address - Street 2:SUITE 10
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1051
Practice Address - Country:US
Practice Address - Phone:716-446-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health