Provider Demographics
NPI:1932663069
Name:FLORES-MEMBRENO, LESLIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:FLORES-MEMBRENO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7987 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4838
Mailing Address - Country:US
Mailing Address - Phone:301-557-1882
Mailing Address - Fax:
Practice Address - Street 1:7987 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4838
Practice Address - Country:US
Practice Address - Phone:301-557-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23234104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty