Leslie Joe Bolin, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY17271 Issued in CA

Practice address

10333 El Camino Real
Atascadero, CA 93422

Phone

(805) 468-2555

Fax

(805) 468-3006

NPI assigned

May 17, 2006

Last updated

Jan 28, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shannon Cantillano Licensed Clinical Social Worker Inc Dba Inner Expansions Therapy Services

  dba Inner Expansions Therapy Services

  • Clinical Social Worker
  • Atascadero, CA
  • NPI 1205543535
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390867200000",
    "number": "1275585002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10333 EL CAMINO REAL, PO BOX 7001",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "93422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10333 EL CAMINO REAL",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "93422",
            "telephone_number": "805-468-2555",
            "fax_number": "805-468-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIN",
        "first_name": "LESLIE",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2014-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY17271",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17271",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Blanc
• Monica Blandford, LMFT
• Blue Sky Psychology Group, Inc.
• Caroline Boddington
• Danica Boggs
• Delmer Edwin Bond Jr., D,D,S,
• Kimberly Bond, MD
• Bonnicksen Speech Therapy (Clear Sky Speech Therapy)
• Kathleen Bono, PSY.D.
• Cassandra Lynn Booker, RADT-I

• Clinical Neuropsychologist in Atascadero, CA
• Providers in Atascadero, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.