Provider Demographics
NPI:1972192839
Name:WINTZ, LESLIE ANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANNE
Last Name:WINTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3905 NATIONAL DR STE 230
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-6101
Mailing Address - Country:US
Mailing Address - Phone:240-650-0779
Mailing Address - Fax:443-583-3872
Practice Address - Street 1:3905 NATIONAL DR STE 230
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6101
Practice Address - Country:US
Practice Address - Phone:240-650-0779
Practice Address - Fax:443-583-3872
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0336103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical