Provider Demographics
NPI:1124530027
Name:ROSS, LEONARD DARREN JR
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:DARREN
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 PARKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2539
Mailing Address - Country:US
Mailing Address - Phone:843-789-9956
Mailing Address - Fax:
Practice Address - Street 1:11821 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-2539
Practice Address - Country:US
Practice Address - Phone:843-789-9956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician