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General NPI Number Information
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NPI Number | 1578891644
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Entity Type | Individual
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Provider Name | LAURENCE NEIL LETICH LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5 HILLCREST DR STE B202
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City | FREDERICK
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State | MD
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Zip | 21703-6269
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Country | US
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Telephone | 240-315-8100
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Fax | 301-865-4559
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Provider Business Mailing Address
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Address Line | 3 HILLCREST DR STE A202
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City | FREDERICK
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State | MD
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Zip | 21703-6270
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Country | US
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Telephone | 240-315-8100
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Fax | 240-377-0302
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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 | 15014
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License Number State | MD
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