Provider Demographics
NPI:1902569775
Name:LEONARD, JORDYN RAE (LCSW)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:RAE
Last Name:LEONARD
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-0001
Mailing Address - Country:US
Mailing Address - Phone:207-806-9141
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-0001
Practice Address - Country:US
Practice Address - Phone:207-806-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC234911041C0700X
MEMC203641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical