Provider Demographics
NPI:1700906112
Name:KUCHEK, LESLEY (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:
Last Name:KUCHEK
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 1:310 94TH ST APT 415
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6941
Mailing Address - Country:US
Mailing Address - Phone:718-260-7832
Mailing Address - Fax:
Practice Address - Street 1:100 N PORTLAND AVE
Practice Address - Street 2:CUMBERLAND DIAGNOSTIC AND TREATMENT CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2005
Practice Address - Country:US
Practice Address - Phone:718-260-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR054166-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical