Provider Demographics
NPI:1255500716
Name:KUBERSKI, LESLIE OWEN (PSYD)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:OWEN
Last Name:KUBERSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 W MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7428
Mailing Address - Country:US
Mailing Address - Phone:559-786-0206
Mailing Address - Fax:559-713-1735
Practice Address - Street 1:19634 VENTURA BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2966
Practice Address - Country:US
Practice Address - Phone:559-786-0206
Practice Address - Fax:559-713-1735
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6824OtherLICENSE NUMBER