Healthcare Provider Details

I. General information

NPI: 1386138089
Provider Name (Legal Business Name): LESLIE CAJAS LAYNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 EDUCATION CT
BROADLANDS VA
20148-5526
US

IV. Provider business mailing address

21000 EDUCATION CT
BROADLANDS VA
20148-5526
US

V. Phone/Fax

Practice location:
  • Phone: 571-252-1013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: