Provider Demographics
NPI:1073531059
Name:FELDER, LEONARD CARL (PHD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:CARL
Last Name:FELDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 OVERLAND AVE STE 780
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3371
Mailing Address - Country:US
Mailing Address - Phone:310-815-1611
Mailing Address - Fax:
Practice Address - Street 1:2566 OVERLAND AVE STE 780
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3371
Practice Address - Country:US
Practice Address - Phone:310-815-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13448103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR16689Medicare UPIN
CACP13448Medicare ID - Type UnspecifiedPSYCHOLOGIST