Provider Demographics
NPI:1740467661
Name:MOORE, LESLEY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3604
Mailing Address - Country:US
Mailing Address - Phone:201-798-9957
Mailing Address - Fax:201-659-6216
Practice Address - Street 1:3040 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3604
Practice Address - Country:US
Practice Address - Phone:201-798-9957
Practice Address - Fax:201-659-6216
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000993001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical