Provider Demographics
NPI:1013065895
Name:GOLDSTEIN, LESLIE MARCIA (LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:MARCIA
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W END AVE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4902
Mailing Address - Country:US
Mailing Address - Phone:212-362-8626
Mailing Address - Fax:212-721-7476
Practice Address - Street 1:180 W END AVE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4902
Practice Address - Country:US
Practice Address - Phone:212-362-8626
Practice Address - Fax:212-721-7476
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01797011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical