Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY10471 | CA |
Y | 103T00000X | Psychologist | PSY10471 | CA |
NPI | 1013095744 |
---|---|
Provider Name | Dr. Andrew M Leeds |
First Address | Santa Rosa, CA 95404-4345 |
Second Address | Santa Rosa, CA 95404-4345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |