Provider Demographics
NPI:1366180291
Name:OLEVSKY, LEON (BCBA)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:OLEVSKY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2914
Mailing Address - Country:US
Mailing Address - Phone:818-600-8758
Mailing Address - Fax:
Practice Address - Street 1:5530 CORBIN AVE STE 221
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6095
Practice Address - Country:US
Practice Address - Phone:818-600-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-59224103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0Medicaid