Provider Demographics
NPI:1538350905
Name:HIRSCH, LESLIE SUGEL (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:SUGEL
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 GLENRIDGE PARK PL
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3453
Mailing Address - Country:US
Mailing Address - Phone:502-657-4553
Mailing Address - Fax:502-426-3388
Practice Address - Street 1:6520 GLENRIDGE PARK PL
Practice Address - Street 2:SUITE ONE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3453
Practice Address - Country:US
Practice Address - Phone:502-657-4553
Practice Address - Fax:502-426-3388
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134681041C0700X
KY36701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical