Provider Demographics
NPI:1992823231
Name:GENNARI, LESLIE MARTYN (LCSW, LMFT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARTYN
Last Name:GENNARI
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 CRAIG RD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4760
Mailing Address - Country:US
Mailing Address - Phone:314-576-0871
Mailing Address - Fax:
Practice Address - Street 1:1810 CRAIG RD
Practice Address - Street 2:SUITE #203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4760
Practice Address - Country:US
Practice Address - Phone:314-576-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0006371041C0700X
MO1999137566106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist