Healthcare Provider Details

I. General information

NPI: 1124249404
Provider Name (Legal Business Name): SEAN CAMERON LESANE MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 RHODE ISLAND AVE NW SUITE #810
WASHINGTON DC
20036-3200
US

IV. Provider business mailing address

2109 4TH ST NE
WASHINGTON DC
20002-1215
US

V. Phone/Fax

Practice location:
  • Phone: 202-549-0288
  • Fax:
Mailing address:
  • Phone: 240-461-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC3000731
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: