Provider Demographics
NPI:1669155289
Name:LESANE, TYLER NICOLE (LGSW)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:NICOLE
Last Name:LESANE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 GARCIA CT UNIT I
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1274
Mailing Address - Country:US
Mailing Address - Phone:252-702-9648
Mailing Address - Fax:
Practice Address - Street 1:1500 FRANKLIN ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2000
Practice Address - Country:US
Practice Address - Phone:202-765-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083188104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker