Provider Demographics
NPI:1831427632
Name:DELISLE, LESLIE ANN (APRN, PMHCNS-BC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:DELISLE
Suffix:
Gender:F
Credentials:APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1571
Mailing Address - Country:US
Mailing Address - Phone:617-538-8232
Mailing Address - Fax:
Practice Address - Street 1:22 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1839
Practice Address - Country:US
Practice Address - Phone:508-580-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250699364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult