Healthcare Provider Details

I. General information

NPI: 1871156232
Provider Name (Legal Business Name): LEDA KAVEH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 QUINCE ORCHARD BLVD STE F
GAITHERSBURG MD
20878-1676
US

IV. Provider business mailing address

845 QUINCE ORCHARD BLVD STE F
GAITHERSBURG MD
20878-1676
US

V. Phone/Fax

Practice location:
  • Phone: 301-769-5878
  • Fax:
Mailing address:
  • Phone: 301-919-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06035
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number06035
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810006256
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: