Provider Demographics
NPI:1083825095
Name:LEITSON, SAGE (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:SAGE
Middle Name:
Last Name:LEITSON
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5266
Mailing Address - Country:US
Mailing Address - Phone:510-875-2300
Mailing Address - Fax:510-875-2310
Practice Address - Street 1:10850 MACARTHUR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5266
Practice Address - Country:US
Practice Address - Phone:510-875-2300
Practice Address - Fax:510-875-2310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist