Healthcare Provider Details

I. General information

NPI: 1003370941
Provider Name (Legal Business Name): CORRINE MARIE LEIKAM PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORRINE MARIE BARNER PSY.D.

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15235 BURBANK BLVD STE B4
VAN NUYS CA
91411-3556
US

IV. Provider business mailing address

PO BOX 3181
THOUSAND OAKS CA
91359-0181
US

V. Phone/Fax

Practice location:
  • Phone: 213-927-6770
  • Fax:
Mailing address:
  • Phone: 818-324-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: