Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1710277165 |
---|---|
Provider Name | Catherine Jo Leslie |
First Address | Springfield, MA 01105-1864 |
Second Address | Springfield, MA 01105-1864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2011 |
Last Update Date | 19/04/2011 |