Provider Demographics
NPI:1689121980
Name:MEYERS, LESLIE (LGSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MEYERS
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 MCCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7260
Mailing Address - Country:US
Mailing Address - Phone:410-444-3800
Mailing Address - Fax:
Practice Address - Street 1:2146 24TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1402
Practice Address - Country:US
Practice Address - Phone:202-774-5442
Practice Address - Fax:202-269-4304
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500797451041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool