Provider Demographics
NPI:1184928947
Name:LEIGHTON, GENINE MARIA (MS, MFT)
Entity type:Individual
Prefix:
First Name:GENINE
Middle Name:MARIA
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 SOQUEL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2855
Mailing Address - Country:US
Mailing Address - Phone:831-566-6830
Mailing Address - Fax:
Practice Address - Street 1:5905 SOQUEL DR
Practice Address - Street 2:STE 200
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2855
Practice Address - Country:US
Practice Address - Phone:831-566-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist