=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770772774
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE C MORAN L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2007
-----------------------------------------------------
Last Update Date | 10/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3033 WILSON BLVD SUITE 500A
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22201-3843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-228-1584
-----------------------------------------------------
Fax | 703-228-1171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10839 AMHERST AVE APT F
-----------------------------------------------------
City | WHEATON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20902-4389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-257-7030
-----------------------------------------------------
Fax | 703-228-1171
-----------------------------------------------------
=====================================================
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 | 0904003934
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------