Provider Demographics
NPI:1992258537
Name:WOOLEY, LEILA REBECA (MA)
Entity type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:REBECA
Last Name:WOOLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:REBECA
Other - Last Name:ALTALEF ROCHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1212H EL CAMINO REAL # 113
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1303
Mailing Address - Country:US
Mailing Address - Phone:650-270-4324
Mailing Address - Fax:
Practice Address - Street 1:840 HINCKLEY RD STE 235
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1547
Practice Address - Country:US
Practice Address - Phone:650-270-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6559101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health