Provider Demographics
NPI:1932115797
Name:LESSANS, ELLEN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:L
Last Name:LESSANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:LEE
Other - Last Name:ROSENBERG-BLOMMESTYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:6112 ROSEMONT CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3554
Mailing Address - Country:US
Mailing Address - Phone:301-570-3310
Mailing Address - Fax:
Practice Address - Street 1:6112 ROSEMONT CIR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3554
Practice Address - Country:US
Practice Address - Phone:301-570-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist