Provider Demographics
NPI:1447673793
Name:LEESER, AMY SUSAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUSAN
Last Name:LEESER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-0487
Mailing Address - Country:US
Mailing Address - Phone:609-667-3461
Mailing Address - Fax:
Practice Address - Street 1:103 PENNSYLVANIA TRL
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-5329
Practice Address - Country:US
Practice Address - Phone:609-667-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00545300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional