Organization
DR. LESLIE LIBERTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE S LIBERTY DSW (BUSINESS OWNER)
(209) 401-5741
Entity
Organization
Contact information
Practice address
924 N YOSEMITE ST, STOCKTON, CA 95203-2217
(209) 401-5741
Mailing address
PO BOX 4212, STOCKTON, CA 95204-0212
(209) 401-5741
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW7173
BOARD OF BEHAVIORAL SCIENCES
CA
Enumeration date
02/10/2021
Last updated
02/10/2021
Update your record
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