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General NPI Number Information
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NPI Number | 1356580211
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Entity Type | Individual
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Provider Name | FERNANDO ANDRE LEYVA PHD.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2009
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 921 RUSSELL AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3252
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Country | US
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Telephone | 301-977-5675
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Fax | 301-963-9070
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Provider Business Mailing Address
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Address Line | 921 RUSSELL AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3252
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Country | US
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Telephone | 301-977-5675
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Fax | 301-963-9070
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2003
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License Number State | MD
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