Provider Demographics
NPI:1669741815
Name:SELF, LEANNE (PSYD)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:SELF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:
Other - Last Name:DIGNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1026 W EL NORTE PKWY # 48
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3341
Mailing Address - Country:US
Mailing Address - Phone:619-395-2885
Mailing Address - Fax:619-393-0390
Practice Address - Street 1:201 E GRAND AVE STE 2A
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2818
Practice Address - Country:US
Practice Address - Phone:619-395-2885
Practice Address - Fax:619-393-0390
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical