Provider Demographics
NPI:1952178170
Name:LEBED, ISABELLA RIANNE
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:RIANNE
Last Name:LEBED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 SMOKE TREE CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1164
Mailing Address - Country:US
Mailing Address - Phone:209-546-2601
Mailing Address - Fax:
Practice Address - Street 1:2905 SMOKE TREE CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1164
Practice Address - Country:US
Practice Address - Phone:209-546-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst