Provider Demographics
NPI:1982072112
Name:HART, LESLIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:HART
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 1:4135 TOWNE GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4954
Mailing Address - Country:US
Mailing Address - Phone:214-223-4589
Mailing Address - Fax:
Practice Address - Street 1:5050 QUORUM DR
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7564
Practice Address - Country:US
Practice Address - Phone:214-223-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical