Provider Demographics
NPI:1699341776
Name:MARTIN, LESLIE BENITA (LMHC,LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:BENITA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-0839
Mailing Address - Country:US
Mailing Address - Phone:917-251-0288
Mailing Address - Fax:
Practice Address - Street 1:4500 W BRIGANTINE AVE APT 1103
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-1466
Practice Address - Country:US
Practice Address - Phone:917-251-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001024101YM0800X
NJ37PC00867300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health