Provider Demographics
NPI:1609069426
Name:BELTON, LEEANNA A (LICSW)
Entity Type:Individual
Prefix:
First Name:LEEANNA
Middle Name:A
Last Name:BELTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5169 CLACTON AVE
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3829
Mailing Address - Country:US
Mailing Address - Phone:978-821-5114
Mailing Address - Fax:301-899-2170
Practice Address - Street 1:5169 CLACTON AVE
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-3829
Practice Address - Country:US
Practice Address - Phone:978-821-5114
Practice Address - Fax:301-899-2170
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159811041C0700X
DCLC500784741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical