MEDICARE: DR. SEAN LEONARD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6552	FL

General Provider Information

NPI Number	:	1871516427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN LEONARD PH.D.

Provider Business Mailing Address
First Line	:	915 MIDDLE RIVER DR
Second Line	:	SUITE 307
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3544
Country	:	US
Telephone Number	:	954-566-2166
Fax Number	:	954-566-1186

Provider Business Practice Location Address
First Line	:	915 MIDDLE RIVER DR
Second Line	:	SUITE 307
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3544
Country	:	US
Telephone Number	:	954-566-2166
Fax Number	:	954-566-1186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. SEAN LEONARD PH.D.” Practice Location

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