Provider Demographics
NPI:1538425152
Name:LEJA, MOLLY (MS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:LEJA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-421-9200
Mailing Address - Fax:909-421-9219
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9200
Practice Address - Fax:909-421-9219
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF76215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist