Organization Active NPI

Lesley Cantor a Family Therapy Professional Corporation

  • Marriage & Family Therapist
  • Sebastopol, CA
National Provider Identifier
1235979709
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
LESLEY CANTOR A FAMILY THERAPY PROFESSIONAL CORPORATION
Practice address
7765 Healdsburg Ave Ste 17
Sebastopol, CA 95472-3310
Phone
(925) 788-3621
NPI assigned
May 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Lesley Aviva Cantor, MFTNPI 1629229893
Title
Ceo
Phone
(925) 788-3621

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

7765 Healdsburg Ave Ste 17
Sebastopol, CA 95472-3310

Mailing address

7765 Healdsburg Ave Ste 17
Sebastopol, CA 95472-3310
Phone (925) 788-3621

Other names 1

  • Lesley Cantor MFT Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241023003265 CA Part B Supplier - Clinic/Group Practice 6709319197 Receives reassigned benefits from 1 practitioner
Practice locations: Sebastopol, CA

National Provider Directory

National Provider Directory

Locations

7765 Healdsburg Ave
Ste 17
Sebastopol, CA 95472
Phone (707) 356-0100

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1717027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1235979709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7765 HEALDSBURG AVE STE 17",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954723310",
            "telephone_number": "925-788-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7765 HEALDSBURG AVE STE 17",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954723310",
            "telephone_number": "925-788-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LESLEY CANTOR A FAMILY THERAPY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-30",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "CANTOR",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_middle_name": "AVIVA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "925-788-3621",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lesley Cantor MFT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sebastopol, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.