Provider Demographics
NPI:1083631097
Name:LEONG, NORMAN (PHD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:LEONG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 STONEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4313
Mailing Address - Country:US
Mailing Address - Phone:301-881-1049
Mailing Address - Fax:301-881-5234
Practice Address - Street 1:6325 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3905
Practice Address - Country:US
Practice Address - Phone:301-881-1049
Practice Address - Fax:301-881-5234
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical