Provider Demographics
NPI:1952745044
Name:CHRISMAN, LESLIE J (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-0077
Mailing Address - Country:US
Mailing Address - Phone:502-517-2553
Mailing Address - Fax:
Practice Address - Street 1:673 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1607
Practice Address - Country:US
Practice Address - Phone:502-516-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical