Provider Demographics
NPI:1043516768
Name:HALPERN, LESLIE RAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:RAY
Last Name:HALPERN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 S SEPULVEDA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3359
Mailing Address - Country:US
Mailing Address - Phone:310-225-2790
Mailing Address - Fax:
Practice Address - Street 1:1554 S SEPULVEDA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3359
Practice Address - Country:US
Practice Address - Phone:310-225-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 11929102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst