Provider Demographics
NPI:1770937476
Name:YADI, LESLIE TAMARA (LCSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:TAMARA
Last Name:YADI
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 1:11393 WILLOW GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6006
Mailing Address - Country:US
Mailing Address - Phone:407-413-0212
Mailing Address - Fax:407-217-6044
Practice Address - Street 1:11393 WILLOW GARDENS DR
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6006
Practice Address - Country:US
Practice Address - Phone:407-413-0212
Practice Address - Fax:407-217-6044
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW64881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical