Provider Demographics
NPI:1114556404
Name:LECKIE, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LECKIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 16TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2549
Mailing Address - Country:US
Mailing Address - Phone:415-476-7000
Mailing Address - Fax:415-502-6361
Practice Address - Street 1:550 16TH ST FL 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2549
Practice Address - Country:US
Practice Address - Phone:415-476-7000
Practice Address - Fax:415-502-6361
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34919103T00000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program