Provider Demographics
NPI:1548392251
Name:MARTIN, LEIGH ROBERTA
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ROBERTA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 CIVIC CT STE 1350
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5279
Mailing Address - Country:US
Mailing Address - Phone:925-212-4933
Mailing Address - Fax:
Practice Address - Street 1:1485 CIVIC CT STE 1350
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5279
Practice Address - Country:US
Practice Address - Phone:925-212-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA51033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist