Provider Demographics
NPI:1851377329
Name:FLEISHER, STEPHAN JAY (PHD)
Entity Type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:JAY
Last Name:FLEISHER
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 1:16031 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-6307
Mailing Address - Country:US
Mailing Address - Phone:818-893-1811
Mailing Address - Fax:818-895-1200
Practice Address - Street 1:16031 CHASE ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-6307
Practice Address - Country:US
Practice Address - Phone:818-893-1811
Practice Address - Fax:818-895-1200
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL53510Medicaid
CA00PL53510Medicaid