MEDICARE: LESLIE KAREN GAMBLE LICSW

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	1041C0700X	Clinical Social Worker	0904010656	VA
2	1041C0700X	Clinical Social Worker	C11630	MS
3	1041C0700X	Clinical Social Worker	I.2304196	OH
4	1041C0700X	Clinical Social Worker	7026	ND
5	1041C0700X	Clinical Social Worker	C014796	NC
6	1041C0700X	Clinical Social Worker	6871	TN
7	1041C0700X	Clinical Social Worker	27201-C	AR
8	1041C0700X	Clinical Social Worker	L16520	OR
9	1041C0700X	Clinical Social Worker	6964	SD
10	1041C0700X	Clinical Social Worker	LC50081506	DC
11	1041C0700X	Clinical Social Worker	17514	LA
12	1041C0700X	Clinical Social Worker	22099	OK
13	1041C0700X	Clinical Social Worker	19631	MD
14	1041C0700X	Clinical Social Worker	4470	NE
15	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-81294	MT

General Provider Information

NPI Number	:	1659794469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE KAREN GAMBLE LICSW

Provider Business Mailing Address
First Line	:	PO BOX 1593
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20725-1593
Country	:	US
Telephone Number	:	301-300-2266
Fax Number	:	240-294-7379

Provider Business Practice Location Address
First Line	:	35 TRIPLE CROWN CT
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-1244
Country	:	US
Telephone Number	:	301-300-2266
Fax Number	:	443-348-7340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	03/03/2026

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