Provider Demographics
NPI:1801169651
Name:MCKENNA, LESLIE SMITH
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:SMITH
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WILL DR
Mailing Address - Street 2:UNIT 99
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3716
Mailing Address - Country:US
Mailing Address - Phone:781-821-3433
Mailing Address - Fax:
Practice Address - Street 1:45 WILL DR
Practice Address - Street 2:UNIT 99
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3716
Practice Address - Country:US
Practice Address - Phone:781-821-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health