Healthcare Provider Details

I. General information

NPI: 1073675419
Provider Name (Legal Business Name): LEAH POTTS FISHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SANTA MARIA WAY
ORINDA CA
94563-2604
US

IV. Provider business mailing address

108 ARDITH DR
ORINDA CA
94563-4202
US

V. Phone/Fax

Practice location:
  • Phone: 925-376-9141
  • Fax: 925-376-3766
Mailing address:
  • Phone: 925-376-9141
  • Fax: 925-376-3766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS4119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: