Active NPI
Michael Stuart Leibow, PSYD, DRPH
- Clinical Psychologist
- Upland, CA
National Provider Identifier
1669817607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY31070
- Practice address
- 954 W Foothill Blvd Ste a
Upland, CA 91786-3782 - Phone
- (909) 946-4222
- Fax
- (909) 946-8243
- NPI assigned
- May 3, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 05438 | MD | |
| Clinical Psychologist | 103TC0700X | PSY31070 | CA | Primary |
Addresses
Primary practice location
954 W Foothill Blvd Ste a
Upland, CA 91786-3782
Mailing address
954 W Foothill Blvd Ste a
Upland, CA 91786-3782
Phone (909) 946-4222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY31070 | CA | MD | Clinical Psychologist |
| 05438 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567555200000",
"number": "1669817607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "954 W FOOTHILL BLVD STE A",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863782",
"telephone_number": "909-946-4222",
"fax_number": "909-946-8243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "954 W FOOTHILL BLVD STE A",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863782",
"telephone_number": "909-946-4222",
"fax_number": "909-946-8243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEIBOW",
"first_name": "MICHAEL",
"middle_name": "STUART",
"name_prefix": "Dr.",
"credential": "PSYD, DRPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-03",
"last_updated": "2019-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05438",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY31070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.