Provider Demographics
NPI:1043495310
Name:WYSOCKI, LEONARD LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:LOUIS
Last Name:WYSOCKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 LAKE RD. NARRAGANSETT R. I. 02882
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-1003
Mailing Address - Country:US
Mailing Address - Phone:860-798-4913
Mailing Address - Fax:
Practice Address - Street 1:243 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3269
Practice Address - Country:US
Practice Address - Phone:860-798-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
CT002834103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling