Provider Demographics
NPI:1144296419
Name:LAMB, LESLIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:LAMB
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GORDON ST
Mailing Address - Street 2:APARTMENT 104
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5262
Mailing Address - Country:US
Mailing Address - Phone:781-894-2504
Mailing Address - Fax:
Practice Address - Street 1:29 GORDON ST
Practice Address - Street 2:APARTMENT 104
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5262
Practice Address - Country:US
Practice Address - Phone:781-894-2504
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10321791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical