Provider Demographics
NPI:1922022466
Name:LEONARD, MANDA S (LPC)
Entity Type:Individual
Prefix:
First Name:MANDA
Middle Name:S
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W RACE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1922
Mailing Address - Country:US
Mailing Address - Phone:814-443-4891
Mailing Address - Fax:814-443-4898
Practice Address - Street 1:245 W RACE ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1922
Practice Address - Country:US
Practice Address - Phone:814-443-4891
Practice Address - Fax:814-443-4898
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000001750065Medicaid
PA1000001750065Medicaid