Healthcare Provider Details

I. General information

NPI: 1316224173
Provider Name (Legal Business Name): LESLI J PREUSS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 LAUREL CANYON BLVD
STUDIO CITY CA
91604-3710
US

IV. Provider business mailing address

3921 LAUREL CANYON BLVD
STUDIO CITY CA
91604-3710
US

V. Phone/Fax

Practice location:
  • Phone: 917-697-2227
  • Fax:
Mailing address:
  • Phone: 917-697-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number23829
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number015180-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: