Provider Demographics
NPI:1740783646
Name:ALLEN, LESLIE RYON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:RYON
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6067 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1329
Mailing Address - Country:US
Mailing Address - Phone:410-319-9681
Mailing Address - Fax:410-319-9688
Practice Address - Street 1:6067 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1329
Practice Address - Country:US
Practice Address - Phone:410-319-9681
Practice Address - Fax:410-319-9688
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical