Healthcare Provider Details

I. General information

NPI: 1164161717
Provider Name (Legal Business Name): LEERON SILBERBERG NOWAK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 OLD MEADOW RD STE 205
MC LEAN VA
22102-4322
US

IV. Provider business mailing address

4425 VENTURA CANYON AVE APT 201
SHERMAN OAKS CA
91423-5001
US

V. Phone/Fax

Practice location:
  • Phone: 703-935-0058
  • Fax:
Mailing address:
  • Phone: 240-643-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: