| Lesley Cantor A Family Therapy Professional Corporation | |
|
7765 Healdsburg Ave Ste 17 Sebastopol CA 95472-3310 | |
| (925) 788-3621 | |
| Not Available |
| Full Name | Lesley Cantor A Family Therapy Professional Corporation |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 7765 Healdsburg Ave Ste 17, Sebastopol, California |
| Authorized Official Name and Position | Lesley Aviva Cantor (CEO) |
| Authorized Official Contact | 9257883621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lesley Cantor A Family Therapy Professional Corporation 7765 Healdsburg Ave Ste 17 Sebastopol CA 95472-3310 Ph: (925) 788-3621 | Lesley Cantor A Family Therapy Professional Corporation 7765 Healdsburg Ave Ste 17 Sebastopol CA 95472-3310 Ph: (925) 788-3621 |
| NPI Number | 1235979709 |
|---|---|
| Provider Enumeration Date | 05/30/2024 |
| Last Update Date | 05/30/2024 |
| Certification Date | 05/30/2024 |
| Medicare PECOS PAC ID | 6709319197 |
|---|---|
| Medicare Enrollment ID | O20241023003265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235979709 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Lesley Aviva Cantor |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1629229893 PECOS PAC ID: 7517490907 Enrollment ID: I20241023003853 |
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