Leyla T Brusatori, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PSY 23080 Issued in CA

Practice address

1812 W Kettleman LN Ste 3
Lodi, CA 95242-4209

Phone

(707) 225-2317

Fax

(209) 593-3000

NPI assigned

Feb 23, 2010

Last updated

Sep 25, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1437471190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 W KETTLEMAN LN STE 3",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424209",
            "telephone_number": "707-225-2317",
            "fax_number": "209-593-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 W KETTLEMAN LN STE 3",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424209",
            "telephone_number": "707-225-2317",
            "fax_number": "209-593-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUSATORI",
        "first_name": "LEYLA",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-23",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY 23080",
            "primary": true
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "CA",
            "license": "PSY 23080",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9940639",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adrien Robin Trent Brooks, PT, DPT
• Angie E Brown, LVN
• Ayanna Brown, M.S.
• Laura Brown
• Cyndi Brunelli
• Jennifer Lee Bryan, OTL
• Marvin D Bryant
• Katharine Cagle Bryda, LMFT
• Manjeet K Bryson, NP RN
• Sara Buchman, PHARMD

• Clinical Child & Adolescent Psychologist in Lodi, CA
• Providers in Lodi, CA by specialty
• Clinical Child & Adolescent Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.