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General NPI Number Information
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NPI Number | 1679395701
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Entity Type | Individual
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Provider Name | JUSTIN LEITER-MCBETH PHD
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Gender | Male
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 5855 SILVER CREEK VALLEY RD
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City | SAN JOSE
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State | CA
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Zip | 95138-1059
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Country | US
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Telephone | 408-574-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 5855 SILVER CREEK VALLEY RD
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City | SAN JOSE
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State | CA
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Zip | 95138-1059
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Country | US
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Telephone | 408-574-9100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 35451
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35451
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License Number State | CA
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