Healthcare Provider Details

I. General information

NPI: 1629232665
Provider Name (Legal Business Name): VICTORIA LEONARD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 11/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 34TH ST
MOUNT RAINIER MD
20712-1737
US

IV. Provider business mailing address

4217 34TH ST
MOUNT RAINIER MD
20712-1737
US

V. Phone/Fax

Practice location:
  • Phone: 202-641-6129
  • Fax:
Mailing address:
  • Phone: 202-641-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberG11180
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLC50078406
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: