Provider Demographics
NPI:1407135619
Name:GLEISINGER, JAMES EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:GLEISINGER
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 1:6520 PLATT AVE
Mailing Address - Street 2:638
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3218
Mailing Address - Country:US
Mailing Address - Phone:818-974-0531
Mailing Address - Fax:
Practice Address - Street 1:6520 PLATT AVE
Practice Address - Street 2:638
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3218
Practice Address - Country:US
Practice Address - Phone:818-974-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13688103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical