Provider Demographics
NPI:1598959835
Name:LELEWER, KRISTIN RUTH (PSYCHOLOGY INTEN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RUTH
Last Name:LELEWER
Suffix:
Gender:F
Credentials:PSYCHOLOGY INTEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 S SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3503
Mailing Address - Country:US
Mailing Address - Phone:310-480-8428
Mailing Address - Fax:310-480-8428
Practice Address - Street 1:633 S SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3503
Practice Address - Country:US
Practice Address - Phone:310-480-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program