Provider Demographics
NPI:1902911274
Name:STONE, LESLIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:STONE
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 1:1 SOUTHSAND
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7414
Mailing Address - Country:US
Mailing Address - Phone:949-733-5556
Mailing Address - Fax:
Practice Address - Street 1:250 W MAIN STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7718
Practice Address - Country:US
Practice Address - Phone:949-733-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASW16849104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW16849AMedicare ID - Type Unspecified