Provider Demographics
NPI:1720368590
Name:GUEDALIA, LEONARD JOEL (PHD)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:JOEL
Last Name:GUEDALIA
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 1:4400 E WEST HWY
Mailing Address - Street 2:SUITE 712
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4524
Mailing Address - Country:US
Mailing Address - Phone:301-907-8995
Mailing Address - Fax:
Practice Address - Street 1:4400 E WEST HWY
Practice Address - Street 2:SUITE 712
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4524
Practice Address - Country:US
Practice Address - Phone:301-907-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist