Provider Demographics
NPI:1225576150
Name:STOCKARD, LEANNA LYNN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LEANNA
Middle Name:LYNN
Last Name:STOCKARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E PIER DR APT 2516
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2955
Mailing Address - Country:US
Mailing Address - Phone:734-624-1943
Mailing Address - Fax:
Practice Address - Street 1:15 NELSON ST FL 2
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2706
Practice Address - Country:US
Practice Address - Phone:603-883-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-12
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH238106H00000X
MALMFT1885106H00000X
IL208.000565106H00000X
IL166.001248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist