Provider Demographics
NPI:1811262868
Name:SMALL, LESLIE F (MS LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:F
Last Name:SMALL
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DAVISON AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1373
Mailing Address - Country:US
Mailing Address - Phone:732-997-0214
Mailing Address - Fax:732-338-7030
Practice Address - Street 1:9 DAVISON AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1373
Practice Address - Country:US
Practice Address - Phone:732-997-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00439900101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health