Provider Demographics
NPI:1316251333
Name:EUSTIS, LESLIE PAGE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:PAGE
Last Name:EUSTIS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:ATTUBATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5646 EVELYN CT APT SUITE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1045
Mailing Address - Country:US
Mailing Address - Phone:504-615-1064
Mailing Address - Fax:914-235-6287
Practice Address - Street 1:433 METAIRIE RD STE 402
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4343
Practice Address - Country:US
Practice Address - Phone:504-615-1064
Practice Address - Fax:504-267-7561
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA121331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA14106346OtherCAQH
LA2381925OtherCOMP PSYCH