Provider Demographics
NPI:1831676774
Name:LAINES, LESLY ESMERALDA
Entity Type:Individual
Prefix:MS
First Name:LESLY
Middle Name:ESMERALDA
Last Name:LAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 COLESVILLE RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-6346
Mailing Address - Country:US
Mailing Address - Phone:703-237-2219
Mailing Address - Fax:703-237-2729
Practice Address - Street 1:8403 COLESVILLE RD STE 1100
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:703-237-2219
Practice Address - Fax:703-237-2729
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician