Provider Demographics
NPI:1336835628
Name:WILSON-LESLIE, SARAH (MS, LAMFT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WILSON-LESLIE
Suffix:
Gender:F
Credentials:MS, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2604
Mailing Address - Country:US
Mailing Address - Phone:929-341-7323
Mailing Address - Fax:
Practice Address - Street 1:27 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2604
Practice Address - Country:US
Practice Address - Phone:929-341-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00033200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist