Provider Demographics
NPI:1487020731
Name:SHERROD, LESLIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SHERROD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20397
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21284-0397
Mailing Address - Country:US
Mailing Address - Phone:410-769-0002
Mailing Address - Fax:
Practice Address - Street 1:8415 BELLONA LN STE 217
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2066
Practice Address - Country:US
Practice Address - Phone:410-384-6287
Practice Address - Fax:443-588-1730
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD169911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical