Provider Demographics
NPI:1710188669
Name:MENDOLA, LEONARD RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:RICHARD
Last Name:MENDOLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1436
Mailing Address - Country:US
Mailing Address - Phone:718-339-8829
Mailing Address - Fax:718-339-5838
Practice Address - Street 1:1614 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1436
Practice Address - Country:US
Practice Address - Phone:718-339-8829
Practice Address - Fax:718-339-5838
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001492101YM0800X
NY000568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist