Healthcare Provider Details

I. General information

NPI: 1225770761
Provider Name (Legal Business Name): LEILANI CHAVEZ LGMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9627 PHILADELPHIA RD STE 160
ROSEDALE MD
21237-4157
US

IV. Provider business mailing address

9627 PHILADELPHIA RD STE 160
ROSEDALE MD
21237-4157
US

V. Phone/Fax

Practice location:
  • Phone: 410-780-5203
  • Fax: 410-780-5205
Mailing address:
  • Phone: 410-780-5203
  • Fax: 410-780-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1153
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: