Provider Demographics
NPI:1316224173
Name:PREUSS, LESLI J (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLI
Middle Name:J
Last Name:PREUSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3710
Mailing Address - Country:US
Mailing Address - Phone:917-697-2227
Mailing Address - Fax:
Practice Address - Street 1:3921 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3710
Practice Address - Country:US
Practice Address - Phone:917-697-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23829103TC2200X
NY015180-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent