Provider Demographics
NPI:1609933647
Name:KUBISIAK, LESLIE GAYLE (MA, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:GAYLE
Last Name:KUBISIAK
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 SPRINGTOWN RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:ALPHA
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-4629
Mailing Address - Country:US
Mailing Address - Phone:908-319-7126
Mailing Address - Fax:
Practice Address - Street 1:1559 SPRINGTOWN RD UNIT A
Practice Address - Street 2:
Practice Address - City:ALPHA
Practice Address - State:NJ
Practice Address - Zip Code:08865-4629
Practice Address - Country:US
Practice Address - Phone:908-319-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00310900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional