Provider Demographics
NPI:1528080827
Name:CAREY, LESLIE J (LCSW-R)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:CAREY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12186-9508
Mailing Address - Country:US
Mailing Address - Phone:518-466-9811
Mailing Address - Fax:518-782-3809
Practice Address - Street 1:711 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2442
Practice Address - Country:US
Practice Address - Phone:518-466-9811
Practice Address - Fax:518-782-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05131811041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0827Medicare ID - Type Unspecified