MEDICARE: CHERYL LEONG MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	52417	CA

General Provider Information

NPI Number	:	1639592769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LEONG MFT

Provider Business Mailing Address
First Line	:	2390 MISSION ST
Second Line	:	STE 301
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-1872
Country	:	US
Telephone Number	:	415-810-2833
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 MISSION ST
Second Line	:	STE 301
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-1872
Country	:	US
Telephone Number	:	415-810-2833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2014
Last Update Date	:	01/24/2014

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