Provider Demographics
NPI:1073938148
Name:ROTTMAN, LESLIE (LMFT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ROTTMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 ALMA REAL DR STE 218
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-5039
Mailing Address - Country:US
Mailing Address - Phone:310-230-7400
Mailing Address - Fax:310-230-7440
Practice Address - Street 1:881 ALMA REAL DR STE 218
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-5039
Practice Address - Country:US
Practice Address - Phone:310-230-7400
Practice Address - Fax:310-230-7440
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist