Provider Demographics
NPI:1295803617
Name:WOODWORTH, LESLIE DIANNE (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DIANNE
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 EATON ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2135
Mailing Address - Country:US
Mailing Address - Phone:781-729-7075
Mailing Address - Fax:781-729-4144
Practice Address - Street 1:38 EATON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2135
Practice Address - Country:US
Practice Address - Phone:781-729-7075
Practice Address - Fax:781-729-4144
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10224691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA008179OtherHARVARD PILGRIM HEALTH CA
MA261466OtherMAGELLAN
MA7927372OtherAETNA
MAP07413OtherBLUE CROSS BLUE SHIELD
MA778485OtherTUFTS HEALTH PLAN
MA008179OtherHARVARD PILGRIM HEALTH CA