Provider Demographics
NPI:1669622965
Name:LEIBOWITZ, MELISSA LAUREN (LCSW, BCBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAUREN
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11465 MOORPARK ST
Mailing Address - Street 2:APT 3
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2032
Mailing Address - Country:US
Mailing Address - Phone:818-614-6979
Mailing Address - Fax:
Practice Address - Street 1:23236 LYONS AVE
Practice Address - Street 2:212
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2635
Practice Address - Country:US
Practice Address - Phone:661-857-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA286141041C0700X
CA1-16-22022103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical