Provider Demographics
NPI:1902569775
Name:LEONARD, JORDYN RAE (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:RAE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-4227
Mailing Address - Country:US
Mailing Address - Phone:207-890-4175
Mailing Address - Fax:
Practice Address - Street 1:300 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4227
Practice Address - Country:US
Practice Address - Phone:207-890-4175
Practice Address - Fax:207-803-8543
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC203641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical