Healthcare Provider Details

I. General information

NPI: 1689739385
Provider Name (Legal Business Name): DAISY LEBRON LPC, PSY.D.CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E PACIFIC COAST HWY STE 100
LONG BEACH CA
90804-3394
US

IV. Provider business mailing address

5150 E PACIFIC COAST HWY STE 100
LONG BEACH CA
90804-3394
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-7600
  • Fax: 562-490-7601
Mailing address:
  • Phone: 562-490-7600
  • Fax: 562-490-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC286
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number89441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: