Provider Demographics
NPI:1699966937
Name:STAHL, LESLEY CAROLINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:CAROLINE
Last Name:STAHL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5287
Mailing Address - Country:US
Mailing Address - Phone:310-740-6710
Mailing Address - Fax:310-794-9574
Practice Address - Street 1:475 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5287
Practice Address - Country:US
Practice Address - Phone:310-740-6710
Practice Address - Fax:310-794-9574
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22374103TB0200X
CA22374103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral