Healthcare Provider Details

I. General information

NPI: 1003252792
Provider Name (Legal Business Name): LESLIE FRIED BEHAR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4966 EL CAMINO REAL SUITE 115
LOS ALTOS CA
94022-1436
US

IV. Provider business mailing address

4966 EL CAMINO REAL SUITE 115
LOS ALTOS CA
94022-1436
US

V. Phone/Fax

Practice location:
  • Phone: 650-947-9717
  • Fax:
Mailing address:
  • Phone: 650-947-9717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY11681
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11681
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY11681
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY11681
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY11681
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY11681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: