Provider Demographics
NPI:1154412328
Name:LESER, KATHLEEN A (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:LESER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BUFORD HWY NE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2149
Mailing Address - Country:US
Mailing Address - Phone:404-402-8590
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY NE
Practice Address - Street 2:SUITE 505
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2149
Practice Address - Country:US
Practice Address - Phone:404-402-8590
Practice Address - Fax:404-315-9235
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23044Medicare UPIN
B0BBFTTMedicare ID - Type Unspecified