MEDICARE: TENLEYTOWN PSYCHIATRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1255186532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENLEYTOWN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	4115 WISCONSIN AVE NW STE 107
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2848
Country	:	US
Telephone Number	:	202-599-7438
Fax Number	:

Provider Business Practice Location Address
First Line	:	4115 WISCONSIN AVE NW STE 107
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2848
Country	:	US
Telephone Number	:	202-599-7438
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER/OWNER
Name	:	MATTHEW LESHCHINER
Credential	:	PMHNP-BC
Telephone Number	:	202-599-7438

Provider Enumeration Date	:	04/20/2024
Last Update Date	:	04/20/2024

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