Provider Demographics
NPI:1912266537
Name:SLEZAK, JUSTYNA J
Entity Type:Individual
Prefix:
First Name:JUSTYNA
Middle Name:J
Last Name:SLEZAK
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 1:17 WINTER ST
Mailing Address - Street 2:#9
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3826
Mailing Address - Country:US
Mailing Address - Phone:617-461-6986
Mailing Address - Fax:
Practice Address - Street 1:17 WINTER ST
Practice Address - Street 2:9
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:617-461-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)