Provider Demographics
NPI:1053561829
Name:LONG, LESLIE LAMPE (LMHC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:LAMPE
Last Name:LONG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:LAMPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 ARNOLD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1034
Mailing Address - Country:US
Mailing Address - Phone:917-359-8923
Mailing Address - Fax:
Practice Address - Street 1:33 ARNOLD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1034
Practice Address - Country:US
Practice Address - Phone:917-359-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health