Provider Demographics
NPI:1922293497
Name:LEPORE, JOSHUA DAVID
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:LEPORE
Suffix:
Gender:M
Credentials:
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 995
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-0995
Mailing Address - Country:US
Mailing Address - Phone:530-292-3478
Mailing Address - Fax:530-292-4296
Practice Address - Street 1:103 PROVIDENCE MINE RD STE 101
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2949
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24947103T00000X
CARPS2010173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health