Provider Demographics
NPI:1518629450
Name:LEONARD, MALLORY RACHEL MERIWETHER (LMHC-A)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:RACHEL MERIWETHER
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-6400
Mailing Address - Country:US
Mailing Address - Phone:401-846-1213
Mailing Address - Fax:
Practice Address - Street 1:42 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6400
Practice Address - Country:US
Practice Address - Phone:401-843-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00131-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health