Provider Demographics
NPI:1083041255
Name:ZIRKIN, LESLIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:ZIRKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 WISCONSIN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3530
Mailing Address - Country:US
Mailing Address - Phone:301-641-4483
Mailing Address - Fax:
Practice Address - Street 1:5480 WISCONSIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3530
Practice Address - Country:US
Practice Address - Phone:301-641-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05192103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist