Provider Demographics
NPI:1760508725
Name:LESLIE K. BARTOLF, PH.D., PROF. PSYCH. CORP.
Entity Type:Organization
Organization Name:LESLIE K. BARTOLF, PH.D., PROF. PSYCH. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTOLF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-824-4994
Mailing Address - Street 1:3551 FLORISTA ST
Mailing Address - Street 2:1D
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2474
Mailing Address - Country:US
Mailing Address - Phone:626-398-1182
Mailing Address - Fax:
Practice Address - Street 1:3551 FLORISTA ST
Practice Address - Street 2:1D
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2474
Practice Address - Country:US
Practice Address - Phone:626-398-1182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13137103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty