Provider Demographics
NPI:1417458563
Name:BRANDENBURG, LESLEY A (BEHAVIOR TECHNIAN)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:A
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 S. LA CIENEGA BLVD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035
Mailing Address - Country:US
Mailing Address - Phone:661-215-5066
Mailing Address - Fax:
Practice Address - Street 1:1601 NEW STINE ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-215-5066
Practice Address - Fax:661-215-5066
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician