Provider Demographics
NPI:1316519168
Name:LEO, KARENA (MS-(PHD GRAD AUGUST))
Entity type:Individual
Prefix:
First Name:KARENA
Middle Name:
Last Name:LEO
Suffix:
Gender:F
Credentials:MS-(PHD GRAD AUGUST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 90399 MED CTR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:801-712-0107
Mailing Address - Fax:
Practice Address - Street 1:2200 W MAIN ST STE 340
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4677
Practice Address - Country:US
Practice Address - Phone:919-684-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist