Provider Demographics
NPI:1356580211
Name:LEYVA, FERNANDO ANDRE (PHD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ANDRE
Last Name:LEYVA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3252
Mailing Address - Country:US
Mailing Address - Phone:301-977-5675
Mailing Address - Fax:301-963-9070
Practice Address - Street 1:921 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3252
Practice Address - Country:US
Practice Address - Phone:301-977-5675
Practice Address - Fax:301-963-9070
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2003103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist