Provider Demographics
NPI:1942404363
Name:PETERSON, LESLIE (MSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 COSMO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3419
Mailing Address - Country:US
Mailing Address - Phone:760-967-7082
Mailing Address - Fax:760-967-1465
Practice Address - Street 1:3142 VISTA WAY STE 207
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3628
Practice Address - Country:US
Practice Address - Phone:760-967-7082
Practice Address - Fax:760-967-1465
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical