Healthcare Provider Details

I. General information

NPI: 1285498246
Provider Name (Legal Business Name): RANDALL SCOTT LEONARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 YORK ROAD STE 800 #1284
TIMONIUM MD
21093-3225
US

IV. Provider business mailing address

1301 YORK ROAD STE 800 #1284
TIMONIUM MD
21093
US

V. Phone/Fax

Practice location:
  • Phone: 443-584-3690
  • Fax:
Mailing address:
  • Phone: 443-584-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RANDALL LEONARD
Title or Position: OWNER
Credential: LCSW-C
Phone: 443-415-4583