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General NPI Number Information
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NPI Number | 1215049564
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Entity Type | Individual
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Provider Name | LESLIE WEITZEL-NICOLL LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 129 W PATRICK ST STE 13B
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City | FREDERICK
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State | MD
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Zip | 21701-5682
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Country | US
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Telephone | 301-873-2348
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Fax |
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Provider Business Mailing Address
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Address Line | 13583 DEER BROOK CT
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City | MOUNT AIRY
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State | MD
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Zip | 21771-4569
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Country | US
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Telephone | 301-829-8626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 08542
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License Number State | MD
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