Provider Demographics
NPI:1285645366
Name:MENON, LEILA P (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:P
Last Name:MENON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LEILA
Other - Middle Name:P
Other - Last Name:MENON ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1 VANDERBILT PARK DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-274-2221
Mailing Address - Fax:828-274-2226
Practice Address - Street 1:1 VANDERBILT PARK DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-274-2221
Practice Address - Fax:828-274-2226
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2511103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1193HOtherBCBS
NC6000000Medicaid
2819134Medicare ID - Type Unspecified