Provider Demographics
NPI:1891122255
Name:LEITCH, JUDITH (LGSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:LEITCH
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 1:314 CARROLL ST NW
Mailing Address - Street 2:418
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2020
Mailing Address - Country:US
Mailing Address - Phone:302-239-8200
Mailing Address - Fax:
Practice Address - Street 1:1701 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4308
Practice Address - Country:US
Practice Address - Phone:202-745-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50079370104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker