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Individual

DR. LEYLA T BRUSATORI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
1812 W KETTLEMAN LN STE 3, LODI, CA 95242-4209
(707) 225-2317
(209) 593-3000
Mailing address
1812 W KETTLEMAN LN STE 3, LODI, CA 95242-4209
(707) 225-2317
(209) 593-3000

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY 23080
CA
103TF0000X
Family Psychologist
PSY 23080
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9940639
CA
Enumeration date
02/23/2010
Last updated
09/25/2018
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