Provider Demographics
NPI:1639106081
Name:HENDRICKS, LEO E JR (PHD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:E
Last Name:HENDRICKS
Suffix:JR
Gender:M
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 FESSENDEN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2029
Mailing Address - Country:US
Mailing Address - Phone:301-942-0678
Mailing Address - Fax:301-942-0079
Practice Address - Street 1:3937 FERRARA DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4709
Practice Address - Country:US
Practice Address - Phone:301-942-0678
Practice Address - Fax:301-942-0079
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC302692104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC806796L66Medicare ID - Type Unspecified