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General NPI Number Information
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NPI Number | 1730632654
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Entity Type | Organization
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Legal Business Name | LESLIE ZIRKIN, CLINICAL PSYCHOLOGIST, LLC
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 4630 MONTGOMERY AVE SUITE 410
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City | BETHESDA
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State | MD
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Zip | 20814-3410
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Country | US
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Telephone | 301-641-4483
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Fax | 240-630-8727
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Provider Business Mailing Address
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Address Line | 4630 MONTGOMERY AVE SUITE 410
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City | BETHESDA
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State | MD
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Zip | 20814-3410
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Country | US
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Telephone | 301-641-4483
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Fax | 240-630-8727
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | LESLIE ZIRKIN
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Credential | PSY.D.
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Telephone | 301-641-4483
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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 | 05192
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License Number State | MD
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