Provider Demographics
NPI:1548314479
Name:LEITCH, DINA SCHWEITZER (MFT)
Entity type:Individual
Prefix:MRS
First Name:DINA
Middle Name:SCHWEITZER
Last Name:LEITCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CALUMET AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960
Mailing Address - Country:US
Mailing Address - Phone:415-308-4461
Mailing Address - Fax:
Practice Address - Street 1:412 RED HILL AVE STE 5
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2468
Practice Address - Country:US
Practice Address - Phone:415-308-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35758106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3651Medicaid