=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598967234
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE MARCIA KROHN LCSWC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6301 N CHARLES ST SUITE 8
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21212-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-377-6370
-----------------------------------------------------
Fax | 410-377-6516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12606 WORTHINGTON RIDGE RD
-----------------------------------------------------
City | REISTERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21136-5520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-356-1511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 04282
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------