Provider Demographics
NPI:1730632654
Name:LESLIE ZIRKIN, CLINICAL PSYCHOLOGIST, LLC
Entity type:Organization
Organization Name:LESLIE ZIRKIN, CLINICAL PSYCHOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIRKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-641-4483
Mailing Address - Street 1:4630 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3410
Mailing Address - Country:US
Mailing Address - Phone:301-641-4483
Mailing Address - Fax:240-630-8727
Practice Address - Street 1:4630 MONTGOMERY AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3410
Practice Address - Country:US
Practice Address - Phone:301-641-4483
Practice Address - Fax:240-630-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05192103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty