Provider Demographics
NPI:1962011338
Name:JEANNEMARIE LEONE, PSYD, CLINICAL PSYCHOLOGIST, PC
Entity Type:Organization
Organization Name:JEANNEMARIE LEONE, PSYD, CLINICAL PSYCHOLOGIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:213-347-9577
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2587
Mailing Address - Country:US
Mailing Address - Phone:213-347-9577
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 203
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:213-347-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty