Provider Demographics
NPI:1710702584
Name:LESNEVICH, EMMA (LGPAT, ATR-P)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:LESNEVICH
Suffix:
Gender:F
Credentials:LGPAT, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27993 SUBSTATION RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-2830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27993 SUBSTATION RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-2830
Practice Address - Country:US
Practice Address - Phone:410-479-1743
Practice Address - Fax:410-479-3674
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATG339221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist