Provider Demographics
NPI:1023350915
Name:LEONARD, BRENDA LEE
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
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 543
Mailing Address - Street 2:34 TOWANTICUT AVE
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-0543
Mailing Address - Country:US
Mailing Address - Phone:508-696-8762
Mailing Address - Fax:508-696-8762
Practice Address - Street 1:34 TOWANTICUT ST
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-2567
Practice Address - Country:US
Practice Address - Phone:508-696-8762
Practice Address - Fax:508-696-8762
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor