Provider Demographics
NPI:1346301181
Name:CONNELL, LESLIE REBECCA (LCSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:REBECCA
Last Name:CONNELL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:REBA
Other - Middle Name:
Other - Last Name:CONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5845 COLLEGE AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1635
Mailing Address - Country:US
Mailing Address - Phone:510-594-8224
Mailing Address - Fax:
Practice Address - Street 1:5845 COLLEGE AVE STE 8
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1635
Practice Address - Country:US
Practice Address - Phone:510-594-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099304921041C0700X
CALCS198141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ26657ZMedicare ID - Type Unspecified