Provider Demographics
NPI:1982794301
Name:TSUKROFF, LESLIE S (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:TSUKROFF
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1919
Mailing Address - Country:US
Mailing Address - Phone:973-879-1678
Mailing Address - Fax:
Practice Address - Street 1:68 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1919
Practice Address - Country:US
Practice Address - Phone:973-879-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047814001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical