Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY 18118 | CA |
Y | 103T00000X | Psychologist | PSY 18118 | CA |
N | 102L00000X | Psychologist | PSY18118 | CA |
N | 103T00000X | Psychologist | PSY18118 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY 18118 | CA |
N | 103G00000X | Clinical Psychologist | PSY 18118 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 18118 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY 18118 | CA |
NPI | 1255433850 |
---|---|
Provider Name | Dr. Sherry Lynn Lebeck |
First Address | Berkeley, CA 94705-1965 |
Second Address | Berkeley, CA 94705-1965 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 15/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY 18118 | (02) | CA |
PSY 18118 | (05) | CA |
PSY 18118 | AETNA (01) | CA |
PSY 18118 | BLUE CROSS/BLUE SHIELD (01) | CA |
PSY 18118 | BLUE SHIELD (01) | CA |
PSY 18118 | MAGELLAN (01) | CA |