Provider Demographics
NPI:1770772774
Name:MORAN, LESLIE C (LCSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:C
Last Name:MORAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10839 AMHERST AVE APT F
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4389
Mailing Address - Country:US
Mailing Address - Phone:301-257-7030
Mailing Address - Fax:703-228-1171
Practice Address - Street 1:3033 WILSON BLVD
Practice Address - Street 2:SUITE 500A
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3843
Practice Address - Country:US
Practice Address - Phone:703-228-1584
Practice Address - Fax:703-228-1171
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040039341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical