Provider Demographics
NPI:1023359569
Name:PORTER, LEANNE PATTERSON (LMFT)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:PATTERSON
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 BAYSHORE HWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1718
Mailing Address - Country:US
Mailing Address - Phone:650-375-0679
Mailing Address - Fax:650-375-0674
Practice Address - Street 1:1499 BAYSHORE HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1718
Practice Address - Country:US
Practice Address - Phone:650-375-0679
Practice Address - Fax:650-375-0674
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist