Provider Demographics
NPI:1437435765
Name:LEONARD, AMY (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CLEARWATER DR
Mailing Address - Street 2:UNIT 147
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1377
Mailing Address - Country:US
Mailing Address - Phone:207-899-6447
Mailing Address - Fax:
Practice Address - Street 1:23 ORONO RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1106
Practice Address - Country:US
Practice Address - Phone:207-899-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC5104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health