Provider Demographics
NPI:1285498246
Name:RANDALL SCOTT LEONARD
Entity type:Organization
Organization Name:RANDALL SCOTT LEONARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-415-4583
Mailing Address - Street 1:1301 YORK ROAD
Mailing Address - Street 2:STE 800 #1284
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:443-584-3690
Mailing Address - Fax:
Practice Address - Street 1:1301 YORK ROAD
Practice Address - Street 2:STE 800 #1284
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3225
Practice Address - Country:US
Practice Address - Phone:443-584-3690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health