Provider Demographics
NPI:1720602238
Name:GABRIELE, LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:GABRIELE
Suffix:
Gender:F
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:PO BOX 991597
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-1597
Mailing Address - Country:US
Mailing Address - Phone:530-410-7337
Mailing Address - Fax:
Practice Address - Street 1:2469 OLD EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0336
Practice Address - Country:US
Practice Address - Phone:530-410-7337
Practice Address - Fax:530-244-0899
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31831103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist