Individual provider Active NPI

Leslie Ann Larson, PH.D.

  • Clinical Psychologist
  • Glendale, CA
National Provider Identifier
1194804336
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY16503 Issued in CA
Practice address
410 Arden Ave Ste 201
Glendale, CA 91203-4006
Phone
(818) 569-5416
Fax
(818) 241-6853
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY16503 CA Primary

Addresses

Primary practice location

410 Arden Ave Ste 201
Glendale, CA 91203-4006

Mailing address

410 Arden Ave Ste 201
Glendale, CA 91203-4006
Phone (818) 569-5416

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260623001017 CA Practitioner - Clinical Psychologist 2567935463 Practice locations: Pasadena, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Pasadena, CA 91105
Phone (818) 569-6516

100 Hurlbut St
Apt 11
Pasadena, CA 91105-3118

100 Hurlbut St Apt
Suite 11
Pasadena, CA 91105-3119

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY16503CAMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194804336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 ARDEN AVE STE 201",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912034006",
            "telephone_number": "818-569-5416",
            "fax_number": "818-241-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 ARDEN AVE STE 201",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912034006",
            "telephone_number": "818-569-5416",
            "fax_number": "818-241-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "LESLIE",
        "middle_name": "ANN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.