Provider Demographics
NPI:1891979860
Name:MAHBOD-KENNY, LEYLA (LICSW)
Entity Type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:
Last Name:MAHBOD-KENNY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 18TH ST NW
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2530
Mailing Address - Country:US
Mailing Address - Phone:202-249-1163
Mailing Address - Fax:
Practice Address - Street 1:1616 18TH ST NW
Practice Address - Street 2:SUITE 112
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2530
Practice Address - Country:US
Practice Address - Phone:202-249-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC30008571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical