Provider Demographics
NPI:1619428091
Name:LEIZEAR, SAMUEL J (MSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:LEIZEAR
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4343
Mailing Address - Country:US
Mailing Address - Phone:301-533-3300
Mailing Address - Fax:301-533-3299
Practice Address - Street 1:1027 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4343
Practice Address - Country:US
Practice Address - Phone:301-533-3300
Practice Address - Fax:301-533-3299
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23589101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV13873109OtherCAQH PROVIDER ID