Provider Demographics
NPI:1043353576
Name:ISIDRO-CLANCY, LETICIA SALO (MA, LPC-MFT, LADC)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:SALO
Last Name:ISIDRO-CLANCY
Suffix:
Gender:F
Credentials:MA, LPC-MFT, LADC
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 BLUFFWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-6764
Mailing Address - Country:US
Mailing Address - Phone:571-231-1292
Mailing Address - Fax:571-231-3224
Practice Address - Street 1:9300 DEWITT LOOP, RIVER PAVILION 2ND FLOOR R2.301
Practice Address - Street 2:FORT BELVOIR COMMUNITY HOSPITAL
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:571-231-1292
Practice Address - Fax:571-231-1283
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00078400106H00000X, 101YM0800X
NJ37LC00082200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)