Provider Demographics
NPI:1598783474
Name:HOLBROOK, LESLIE JEAN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JEAN
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:JEAN
Other - Last Name:PALUMBERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1415 PANTHER LANE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7874
Mailing Address - Country:US
Mailing Address - Phone:239-777-4843
Mailing Address - Fax:239-591-6601
Practice Address - Street 1:1415 PANTHER LANE
Practice Address - Street 2:SUITE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7874
Practice Address - Country:US
Practice Address - Phone:239-777-4843
Practice Address - Fax:239-591-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 69951041C0700X
FLSW6995104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ026ROtherB/C B/S
FLZ026ROtherB/C B/S
FLZ026ROtherB/C B/S