Provider Demographics
NPI:1790284156
Name:MENDEZ CARMONA, LEAH M (LPCC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:MENDEZ CARMONA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 N MARKET ST STE B
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-3567
Mailing Address - Country:US
Mailing Address - Phone:330-227-1670
Mailing Address - Fax:877-689-3623
Practice Address - Street 1:2685 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9041
Practice Address - Country:US
Practice Address - Phone:330-345-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2001809-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0267373Medicaid