Provider Demographics
NPI:1073768008
Name:MAYWEATHER, LENARD I
Entity Type:Individual
Prefix:
First Name:LENARD
Middle Name:I
Last Name:MAYWEATHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 SAN JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-2411
Mailing Address - Country:US
Mailing Address - Phone:213-488-0031
Mailing Address - Fax:213-488-4934
Practice Address - Street 1:627 SAN JULIAN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-2411
Practice Address - Country:US
Practice Address - Phone:213-488-0031
Practice Address - Fax:213-488-4934
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health