Healthcare Provider Details

I. General information

NPI: 1609978477
Provider Name (Legal Business Name): LEINE MARIE DELKER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD SUITE 122
PASADENA CA
91105-2544
US

IV. Provider business mailing address

PO BOX 50786
PASADENA CA
91115-0786
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-4928
  • Fax: 626-792-6504
Mailing address:
  • Phone: 626-577-4928
  • Fax: 626-792-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: