Provider Demographics
NPI:1700988540
Name:MATHESON, LEONARD NEIL (PHD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:NEIL
Last Name:MATHESON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 BLOOMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9423
Mailing Address - Country:US
Mailing Address - Phone:636-346-8869
Mailing Address - Fax:636-898-0954
Practice Address - Street 1:48 HANOVER LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7224
Practice Address - Country:US
Practice Address - Phone:636-346-8869
Practice Address - Fax:636-898-0954
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9294103T00000X
MOPYR0533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist