Provider Demographics
NPI:1104124874
Name:SANDS, LESLIE (LICSW, CHHC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:SANDS
Suffix:
Gender:F
Credentials:LICSW, CHHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EAST INDIA SQUARE
Mailing Address - Street 2:MUSEUM PLACE MALL, A SACRED PLACE
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-744-1600
Mailing Address - Fax:
Practice Address - Street 1:2 EAST INDIA SQUARE
Practice Address - Street 2:A SACRED PLACE
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3700
Practice Address - Country:US
Practice Address - Phone:978-744-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1070611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8877665544Medicare PIN