Provider Demographics
NPI:1578096608
Name:LERBA, LEORA
Entity Type:Individual
Prefix:
First Name:LEORA
Middle Name:
Last Name:LERBA
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 1:215 7TH ST # 370774
Mailing Address - Street 2:
Mailing Address - City:MONTARA
Mailing Address - State:CA
Mailing Address - Zip Code:94037-9998
Mailing Address - Country:US
Mailing Address - Phone:415-632-6692
Mailing Address - Fax:
Practice Address - Street 1:215 7TH ST # 370774
Practice Address - Street 2:
Practice Address - City:MONTARA
Practice Address - State:CA
Practice Address - Zip Code:94037-9998
Practice Address - Country:US
Practice Address - Phone:415-632-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT126246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist