Healthcare Provider Details

I. General information

NPI: 1619162260
Provider Name (Legal Business Name): ANDREW JOSEPH LEONE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 06/27/2022
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10940 WILSHIRE BLVD STE 600
LOS ANGELES CA
90024-3940
US

IV. Provider business mailing address

1429 VALLEY VIEW RD APT 27
GLENDALE CA
91202-1773
US

V. Phone/Fax

Practice location:
  • Phone: 415-519-5961
  • Fax: 714-352-6471
Mailing address:
  • Phone: 415-519-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: