Provider Demographics
NPI:1235689365
Name:CAROL L LEONARD PHD LLC
Entity Type:Organization
Organization Name:CAROL L LEONARD PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-653-4517
Mailing Address - Street 1:6 DRAGONFLY DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5572
Mailing Address - Country:US
Mailing Address - Phone:207-653-4517
Mailing Address - Fax:
Practice Address - Street 1:219 ROOSEVELT TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4396
Practice Address - Country:US
Practice Address - Phone:207-653-4517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1425103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty