Provider Demographics
NPI:1316041429
Name:LEISERSOHN, FELICIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:
Last Name:LEISERSOHN
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 1:8348 TRAFORD LANE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152
Mailing Address - Country:US
Mailing Address - Phone:703-569-8731
Mailing Address - Fax:703-569-7248
Practice Address - Street 1:8348 TRAFORD LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152
Practice Address - Country:US
Practice Address - Phone:703-569-8731
Practice Address - Fax:703-569-7248
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical