MEDICARE: DR. JUSTIN LEITER-MCBETH PHD

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	103TH0004X	Health Psychologist	35451	CA
2	103TC0700X	Clinical Psychologist	35451	CA

General Provider Information

NPI Number	:	1679395701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN LEITER-MCBETH PHD

Provider Business Mailing Address
First Line	:	21015 PATHFINDER RD
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-4018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 SILVER CREEK VALLEY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1059
Country	:	US
Telephone Number	:	408-574-9100
Fax Number	:

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

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	01/28/2026

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