Provider Demographics
NPI:1942531876
Name:LEEB, CHARLES SAMUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SAMUEL
Last Name:LEEB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 WEST FIRST STREET
Mailing Address - Street 2:SUITE 246
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3720
Mailing Address - Country:US
Mailing Address - Phone:909-238-8001
Mailing Address - Fax:909-399-9704
Practice Address - Street 1:250 WEST FIRST STREET
Practice Address - Street 2:SUITE 246
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3720
Practice Address - Country:US
Practice Address - Phone:909-238-8001
Practice Address - Fax:909-399-9704
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7880103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical