Healthcare Provider Details

I. General information

NPI: 1174714422
Provider Name (Legal Business Name): LESLIE ESSENWANGER CHERAMY MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W COLTON AVE STE C
REDLANDS CA
92374-2905
US

IV. Provider business mailing address

802 W COLTON AVE STE C
REDLANDS CA
92374-2905
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-2989
  • Fax: 909-335-1701
Mailing address:
  • Phone: 909-335-2989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number39138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: