Provider Demographics
NPI:1780722702
Name:WINSLOW-KEATS, LESLIE NORA (LMHC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:NORA
Last Name:WINSLOW-KEATS
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 1:24 SOUTH ST
Mailing Address - Street 2:UNIT #22
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4475
Mailing Address - Country:US
Mailing Address - Phone:781-395-2958
Mailing Address - Fax:
Practice Address - Street 1:20 EASTBROOK ROAD
Practice Address - Street 2:STRATTUS...TILL'S BEHAVIORAL HEALTH CENTRE
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-302-4752
Practice Address - Fax:781-302-4635
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5722101YM0800X
NY000904-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health