Provider Demographics
NPI:1255433850
Name:LEBECK, SHERRY LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LYNN
Last Name:LEBECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 TELEGRAPH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1965
Mailing Address - Country:US
Mailing Address - Phone:510-282-5524
Mailing Address - Fax:510-526-2973
Practice Address - Street 1:3120 TELEGRAPH AVE STE 10
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1965
Practice Address - Country:US
Practice Address - Phone:510-282-5524
Practice Address - Fax:510-526-2973
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18118103T00000X, 103TB0200X, 103TC0700X, 103TR0400X
CAPSY18118103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 18118OtherMAGELLAN
CAPSY 18118OtherBLUE CROSS/BLUE SHIELD
CAPSY 18118OtherAETNA
CAPSY 18118Medicaid
CAPSY 18118OtherBLUE SHIELD
CAPSY 18118OtherBLUE CROSS/BLUE SHIELD
CAOPL181180Medicare ID - Type Unspecified