1194818187 NPI number — DR. STEPHEN ALAN LESCHT DSW LCSWC

Table of content: DR. STEPHEN ALAN LESCHT DSW LCSWC (NPI 1194818187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194818187 NPI number — DR. STEPHEN ALAN LESCHT DSW LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESCHT
Provider First Name:
STEPHEN
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DSW LCSWC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194818187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
692 RITCHIE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-544-3336
Provider Business Mailing Address Fax Number:
410-544-6725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
692 RITCHIE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-544-3336
Provider Business Practice Location Address Fax Number:
410-544-6725
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  01244 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003276 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q214 . This is a "CARE FIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R5770001 . This is a "CARE FIRST NATIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R5770001 . This is a "CARE FIRST NATIONAL" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: R5770001 . This is a "CARE FIRST NATIONAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 154786 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".




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