Provider Demographics
NPI:1396329850
Name:LEARD, CHEYENNE L (LCSW)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:L
Last Name:LEARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1622
Mailing Address - Country:US
Mailing Address - Phone:401-440-4606
Mailing Address - Fax:
Practice Address - Street 1:25 W INDEPENDENCE WAY # 1127
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1126
Practice Address - Country:US
Practice Address - Phone:401-789-4614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW025271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICSW02527OtherRI DEPARTMENT OF HEALTH