Individual provider Active NPI

Gerald Joseph Leboeuf Jr., LMFT

  • Marriage & Family Therapist
  • Riverside, CA
National Provider Identifier
1831529973
Registry record updated May 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT 83961 Issued in CA
Practice address
769 W. Blaine Street BLDG B
Riverside, CA 92501-3613
Phone
(951) 358-4705
NPI assigned
Nov 26, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X IMF 72876 CA
Marriage & Family Therapist 106H00000X LMFT 83961 CA Primary

Addresses

Primary practice location

769 W. Blaine Street BLDG B
Riverside, CA 92501-3613

Mailing address

769 W Blaine St Ste B
Riverside, CA 92507-3970
Phone (951) 358-4705

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
I20240930000415 CA Practitioner - Marriage and Family Therapist 5092246215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

1255 W Arrow Hwy
San Dimas, CA 91773-2340
Phone (909) 394-2526

1502 W W Covina Pkwy
West Covina, CA 91790-2703
Phone (626) 960-4845

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
IMF 72876CAMDMental Health Counselor
LMFT 83961CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jun 17, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 17, 2024 Accepting new patients

Locations

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430438400000",
    "number": "1831529973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "769 W BLAINE ST STE B",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925073970",
            "telephone_number": "951-358-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "769 W. BLAINE STREET BLDG B",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013613",
            "telephone_number": "951-358-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBOEUF",
        "first_name": "GERALD",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-26",
        "last_updated": "2015-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "IMF 72876",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT 83961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.