Provider Demographics
NPI:1760420020
Name:LEONHARD, MARGARET L (PSYD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:LEONHARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175947
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5947
Mailing Address - Country:US
Mailing Address - Phone:859-992-2958
Mailing Address - Fax:859-283-5155
Practice Address - Street 1:7711 EWING BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7533
Practice Address - Country:US
Practice Address - Phone:859-992-2958
Practice Address - Fax:859-283-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1444103TC2200X, 103TC0700X, 103TA0700X
OH6434103TC2200X, 103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100026230Medicaid
RR018OtherRAILROAD MEDICARE
KYCP00213Medicare PIN