Provider Demographics
NPI:1114053105
Name:SOLOMON, LESLIE MANDELSTAMM (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MANDELSTAMM
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEARTHSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2644
Mailing Address - Country:US
Mailing Address - Phone:301-424-1987
Mailing Address - Fax:
Practice Address - Street 1:13975 CONNECTICUT AVE STE 207
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2921
Practice Address - Country:US
Practice Address - Phone:301-424-1987
Practice Address - Fax:301-424-2644
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD076041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD128835Medicare UPIN