Provider Demographics
NPI:1710164512
Name:LESKO, STACEY BETH (LGSW)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:BETH
Last Name:LESKO
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHOKE CHERRY ROAD
Mailing Address - Street 2:ROOM 6-1070
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20857-0001
Mailing Address - Country:US
Mailing Address - Phone:240-276-1390
Mailing Address - Fax:240-276-1340
Practice Address - Street 1:8901 ROCKVILLE PIKE
Practice Address - Street 2:BUILDING 9, ROOM 3101
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-295-0500
Practice Address - Fax:301-295-6720
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50078473104100000X
MDG12378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker