Provider Demographics
NPI:1194237602
Name:TUBUL, LESLIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:TUBUL
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 1:30 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5606
Mailing Address - Country:US
Mailing Address - Phone:973-396-7900
Mailing Address - Fax:
Practice Address - Street 1:51 UPPER MONTCLAIR PLZ STE 25
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1340
Practice Address - Country:US
Practice Address - Phone:862-505-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056436001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical