Provider Demographics
NPI:1679861827
Name:OLIVER, LEAH LOUISE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:LOUISE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 55TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2609
Mailing Address - Country:US
Mailing Address - Phone:510-655-7880
Mailing Address - Fax:510-655-3379
Practice Address - Street 1:1375 55TH ST
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2609
Practice Address - Country:US
Practice Address - Phone:510-655-7880
Practice Address - Fax:510-655-3379
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health