Provider Demographics
NPI:1992158570
Name:LEAL, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:37 AUBURN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1846
Mailing Address - Country:US
Mailing Address - Phone:626-470-9834
Mailing Address - Fax:
Practice Address - Street 1:37 AUBURN AVE STE 1
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1846
Practice Address - Country:US
Practice Address - Phone:626-470-9834
Practice Address - Fax:866-541-3233
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist