Provider Demographics
NPI:1083770861
Name:LEONARD, CARLA A (RN, CS-P)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:A
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RN, CS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 REGAL LN
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-1404
Mailing Address - Country:US
Mailing Address - Phone:410-903-2806
Mailing Address - Fax:
Practice Address - Street 1:1206 REGAL LN
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-1404
Practice Address - Country:US
Practice Address - Phone:410-903-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR094983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPR26CAOtherBLUECROSS BLUESHIELD
MD7594691OtherAETNA
MDPV127443OtherAPS HEALTHCARE