Provider Demographics
NPI:1184212656
Name:SEGEV, LESLIE DARA
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:DARA
Last Name:SEGEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 PLUM HILL CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5122
Mailing Address - Country:US
Mailing Address - Phone:410-300-9275
Mailing Address - Fax:
Practice Address - Street 1:9030 ROUTE 108 STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1990
Practice Address - Country:US
Practice Address - Phone:410-740-1901
Practice Address - Fax:410-740-2503
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD202821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical