Provider Demographics
NPI:1023101904
Name:LESKIN, GREGORY ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:LESKIN
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 1:11150 W. OLYMPIC BLVD.
Mailing Address - Street 2:SUITE 650
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1822
Mailing Address - Country:US
Mailing Address - Phone:310-235-2633
Mailing Address - Fax:310-235-2612
Practice Address - Street 1:11150 W. OLYMPIC BLVD.
Practice Address - Street 2:SUITE 650
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1822
Practice Address - Country:US
Practice Address - Phone:310-235-2633
Practice Address - Fax:310-235-2612
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY25345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist