Provider Demographics
NPI:1144255316
Name:LEONHARDT, MERRILEE (MD)
Entity type:Individual
Prefix:
First Name:MERRILEE
Middle Name:
Last Name:LEONHARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BRIDGE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-3107
Mailing Address - Country:US
Mailing Address - Phone:860-254-5360
Mailing Address - Fax:
Practice Address - Street 1:68 BRIDGE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-3107
Practice Address - Country:US
Practice Address - Phone:860-254-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0293632084P0800X
WY10637A2084P0800X
CODR.00567942084P0800X
IDM-132802084P0800X
WAMD606462392084P0800X
NMMD2016-02742084P0800X
CAG1434452084P0800X
HIMD-187002084P0800X
MTMED-PHYS-LIC-502232084P0800X
NV166652084P0800X
AK1142992084P0800X
ORMD1766772084P0800X
AZ523102084P0800X
MA711132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3064671Medicaid
5000560OtherTUFTS HEALTH PLAN
MA998296OtherNETWORK HEALTH
MA998296OtherNETWORK HEALTH
J10280Medicare ID - Type Unspecified