Provider Demographics
NPI:1598446999
Name:LEER, MARIE ANTOINETTE
Entity type:Individual
Prefix:
First Name:MARIE ANTOINETTE
Middle Name:
Last Name:LEER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE ANTOINETTE
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 AIRPORT BLVD STE 490&495
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1908
Mailing Address - Country:US
Mailing Address - Phone:650-517-8220
Mailing Address - Fax:
Practice Address - Street 1:700 AIRPORT BLVD STE 490&495
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1908
Practice Address - Country:US
Practice Address - Phone:650-517-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1168651041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical