Provider Demographics
NPI:1538039953
Name:ROSTAMI, LEYLI
Entity type:Individual
Prefix:
First Name:LEYLI
Middle Name:
Last Name:ROSTAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20344 LORNE ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1824
Mailing Address - Country:US
Mailing Address - Phone:818-836-1203
Mailing Address - Fax:
Practice Address - Street 1:20344 LORNE ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-1824
Practice Address - Country:US
Practice Address - Phone:818-836-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA159314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty