Provider Demographics
NPI:1962228163
Name:PAMELA LESLIE MSW LISW-S
Entity type:Organization
Organization Name:PAMELA LESLIE MSW LISW-S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-664-2074
Mailing Address - Street 1:2012 ASHLEY OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-6269
Mailing Address - Country:US
Mailing Address - Phone:863-664-2074
Mailing Address - Fax:
Practice Address - Street 1:2012 ASHLEY OAKS CIR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-6269
Practice Address - Country:US
Practice Address - Phone:863-664-2074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty