Healthcare Provider Details

I. General information

NPI: 1780359240
Provider Name (Legal Business Name): ANDREW J LEONE, PSYD A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E HILLCREST DR STE 115
THOUSAND OAKS CA
91360-7782
US

IV. Provider business mailing address

11759 SEMINOLE CIR
PORTER RANCH CA
91326-1423
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW JOSEPH LEONE
Title or Position: OWNER
Credential: PSYD
Phone: 415-519-5961