Provider Demographics
NPI:1316186208
Name:F. ANDRE LEYVA PHD.
Entity Type:Organization
Organization Name:F. ANDRE LEYVA PHD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-977-5675
Mailing Address - Street 1:921 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3252
Mailing Address - Country:US
Mailing Address - Phone:301-977-5675
Mailing Address - Fax:
Practice Address - Street 1:921 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3252
Practice Address - Country:US
Practice Address - Phone:301-977-5675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2003261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)