Provider Demographics
NPI:1730070517
Name:BRAND-LESLEY, STACY LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:BRAND-LESLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 W STATE ROAD 2
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-9475
Mailing Address - Country:US
Mailing Address - Phone:574-302-1661
Mailing Address - Fax:
Practice Address - Street 1:9051 W STATE ROAD 2
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-9475
Practice Address - Country:US
Practice Address - Phone:574-302-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34012053A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical