Provider Demographics
NPI:1679149363
Name:LESLIE, LAURA BETH
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:LESLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 KIRKWOOD HWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-738-4539
Mailing Address - Fax:302-266-0881
Practice Address - Street 1:2644 KIRKWOOD HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-738-4539
Practice Address - Fax:302-266-0881
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health