Provider Demographics
NPI:1316069636
Name:TERRY-LEONARD, BRENDA L (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:L
Last Name:TERRY-LEONARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10831 VISTA GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4263
Mailing Address - Country:US
Mailing Address - Phone:301-332-0892
Mailing Address - Fax:202-232-4394
Practice Address - Street 1:333 HAWAII AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-232-4270
Practice Address - Fax:202-232-4394
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03794103TC1900X, 103TC2200X, 103TF0000X
DCPSY1000116103TC2200X, 103TP2701X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy