Provider Demographics
NPI:1629229893
Name:CANTOR, LESLEY AVIVA (LMFT)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:AVIVA
Last Name:CANTOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7765 HEALDSBURG AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3310
Mailing Address - Country:US
Mailing Address - Phone:925-788-3621
Mailing Address - Fax:707-604-6157
Practice Address - Street 1:7765 HEALDSBURG AVE STE 17
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:925-788-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA49867106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist