Leslie Diane Weed Fonner, LICSW

NPI #1255513719 in Berlin, Vermont

Provider Information

NPI Number: 1255513719
Entity Type: Individual
Name: Leslie Diane Weed Fonner, LICSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker - Clinical
Credential: LICSW
Enumeration Date: Nov 27, 2007
Last Updated: Nov 19, 2015

Practice Location

Address: 174 HOSPITAL LOOP
City: Berlin
State: Vermont
ZIP Code: 05602-9105
Phone: (802) 479-4083

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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