Provider Demographics
NPI:1073540928
Name:DI LEONARDO, CONCETTA MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:CONCETTA
Middle Name:MARY
Last Name:DI LEONARDO
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:32 JUNIPER HILL DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6434
Mailing Address - Country:US
Mailing Address - Phone:401-827-0728
Mailing Address - Fax:401-457-3371
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:BUILDING 2--SUITE 210
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-884-2008
Practice Address - Fax:401-884-2075
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPS00095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical