Provider Demographics
NPI:1265749311
Name:KORTVELY, LEIORA (LCSW, LCSW-C, CST)
Entity type:Individual
Prefix:
First Name:LEIORA
Middle Name:
Last Name:KORTVELY
Suffix:
Gender:F
Credentials:LCSW, LCSW-C, CST
Other - Prefix:
Other - First Name:LEIORA
Other - Middle Name:R
Other - Last Name:FREEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9722 GROFFS MILL DR STE 899
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6341
Mailing Address - Country:US
Mailing Address - Phone:410-656-9353
Mailing Address - Fax:
Practice Address - Street 1:5000 THAYER CTR STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1139
Practice Address - Country:US
Practice Address - Phone:410-656-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ORL74091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty