Provider Demographics
NPI:1487670519
Name:PARKER, LESLIE ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 CALVERTON ST
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4154
Mailing Address - Country:US
Mailing Address - Phone:410-744-4017
Mailing Address - Fax:410-744-4145
Practice Address - Street 1:5707 CALVERTON ST
Practice Address - Street 2:STE 1-C
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4154
Practice Address - Country:US
Practice Address - Phone:410-744-4017
Practice Address - Fax:410-744-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1347103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging