Provider Demographics
NPI:1164155883
Name:PASSOS SOARES, LEANDRO (MS,MS, PHD)
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:
Last Name:PASSOS SOARES
Suffix:
Gender:M
Credentials:MS,MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 VILLAGE TOWNES WALK
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5601
Mailing Address - Country:US
Mailing Address - Phone:984-261-6599
Mailing Address - Fax:
Practice Address - Street 1:521 N 11TH ST RM 417
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5016
Practice Address - Country:US
Practice Address - Phone:804-828-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04110000771223P0700X
1041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1223P0700XDental ProvidersDentistProsthodontics
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0411000077OtherDENTAL FACULTY LICENSE
5874OtherHEALTH PARTNERS
568946544OtherBCBS