Provider Demographics
NPI:1821077520
Name:PERRY, LEONARD CLARK (LMSW)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:CLARK
Last Name:PERRY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 S PATRICK DR
Mailing Address - Street 2:45 MDOS/SGOH
Mailing Address - City:PATRICK AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32925
Mailing Address - Country:US
Mailing Address - Phone:321-494-8171
Mailing Address - Fax:321-494-8074
Practice Address - Street 1:1381 S PATRICK DR
Practice Address - Street 2:45 MDOS/SGOH
Practice Address - City:PATRICK AFB
Practice Address - State:FL
Practice Address - Zip Code:32925
Practice Address - Country:US
Practice Address - Phone:321-494-8171
Practice Address - Fax:321-494-8074
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010209401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical