Healthcare Provider Details

I. General information

NPI: 1306996764
Provider Name (Legal Business Name): CAITLIN ELIZABETH LEPORE PH.D, L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VETERAN AVE
LOS ANGELES CA
90095-7142
US

IV. Provider business mailing address

1000 VETERAN AVE
LOS ANGELES CA
90095-7142
US

V. Phone/Fax

Practice location:
  • Phone: 310-983-3121
  • Fax:
Mailing address:
  • Phone: 310-983-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27441
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: