Individual
DR. BRODERICK LEAKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
595 E COLORADO BLVD, SUITE 708, PASADENA, CA 91101-2039
(626) 421-8956
Mailing address
595 E COLORADO BLVD, SUITE 708, PASADENA, CA 91101-2039
(626) 421-8956
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 24273
CA
Other
Enumeration date
06/13/2011
Last updated
06/13/2011
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