Provider Demographics
NPI:1528007911
Name:HERZIK, LESLIE CAROLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:CAROLE
Last Name:HERZIK
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 1:235 E 10TH ST
Mailing Address - Street 2:APT 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7606
Mailing Address - Country:US
Mailing Address - Phone:212-780-9475
Mailing Address - Fax:212-780-9475
Practice Address - Street 1:85 5TH AVE
Practice Address - Street 2:SUITE 921
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3019
Practice Address - Country:US
Practice Address - Phone:917-710-1872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070492-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical