Provider Demographics
NPI:1962557827
Name:WEISMAN, LESLIE JOY (LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JOY
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1736
Mailing Address - Country:US
Mailing Address - Phone:703-385-4278
Mailing Address - Fax:703-228-5234
Practice Address - Street 1:5319 LEE HWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1607
Practice Address - Country:US
Practice Address - Phone:703-385-4278
Practice Address - Fax:703-228-5234
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5027-0001Medicare UPIN