Provider Demographics
NPI:1154512929
Name:LEONARD, EFFIE D
Entity Type:Individual
Prefix:
First Name:EFFIE
Middle Name:D
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1325
Mailing Address - Country:US
Mailing Address - Phone:323-217-8286
Mailing Address - Fax:
Practice Address - Street 1:3929 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1325
Practice Address - Country:US
Practice Address - Phone:323-217-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional