Provider Demographics
NPI:1407388358
Name:LEONARD, RANDALL SCOTT (LCSW-C)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:SCOTT
Last Name:LEONARD
Suffix:
Gender:X
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:21093-5505
Mailing Address - Country:US
Mailing Address - Phone:443-584-3690
Mailing Address - Fax:410-234-8177
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:21093-5505
Practice Address - Country:US
Practice Address - Phone:443-584-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD198761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical