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NPI Code Detail

MEDICARE: LEIORA KORTVELY LCSW, LCSW-C, CST

MEDICARE: LEIORA KORTVELY LCSW, LCSW-C, CST
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1265749311
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEIORA KORTVELY LCSW, LCSW-C, CST
Provider Business Mailing Address
First Line : 9722 GROFFS MILL DR STE 899
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-6341
Country : US
Telephone Number : 410-656-9353
Fax Number :
Provider Business Practice Location Address
First Line : 5000 THAYER CTR STE C
Second Line :
City : OAKLAND
State : MD
Zip : 21550-1139
Country : US
Telephone Number : 410-656-9353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2010
Last Update Date : 03/01/2023

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