Provider Demographics
NPI:1104930734
Name:PACHECO, LESLEY DALE (MSW)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:DALE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050A 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87117-5522
Mailing Address - Country:US
Mailing Address - Phone:505-846-0139
Mailing Address - Fax:
Practice Address - Street 1:2050 A 2ND STREET
Practice Address - Street 2:
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87117
Practice Address - Country:US
Practice Address - Phone:505-846-0139
Practice Address - Fax:505-846-6250
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-43111041C0700X
NMI-068271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical