Provider Demographics
NPI:1750586913
Name:SUSHINSKY, LEONARD WAYNE (PHD)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:WAYNE
Last Name:SUSHINSKY
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 1:18040 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4631
Mailing Address - Country:US
Mailing Address - Phone:818-758-1221
Mailing Address - Fax:818-758-1336
Practice Address - Street 1:18040 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4631
Practice Address - Country:US
Practice Address - Phone:818-758-1221
Practice Address - Fax:818-758-1336
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5187103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist