Provider Demographics
NPI:1629356530
Name:LESSER, JAMIE NICOLE FLACK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:NICOLE FLACK
Last Name:LESSER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:NICOLE
Other - Last Name:FLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 QUAIL ST STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2734
Mailing Address - Country:US
Mailing Address - Phone:949-222-2848
Mailing Address - Fax:
Practice Address - Street 1:1500 QUAIL ST STE 250
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2734
Practice Address - Country:US
Practice Address - Phone:949-222-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY27041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program