Provider Demographics
NPI:1649210691
Name:LESCH, RICHARD STEVEN (PHD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:STEVEN
Last Name:LESCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2512
Mailing Address - Country:US
Mailing Address - Phone:707-477-8907
Mailing Address - Fax:
Practice Address - Street 1:222 WELLER ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3183
Practice Address - Country:US
Practice Address - Phone:707-477-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#12976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24937ZMedicare ID - Type Unspecified