Provider Demographics
NPI:1801957329
Name:KANTROWITZ, LEE MICHAEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:MICHAEL
Last Name:KANTROWITZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30101 TOWN CENTER DR
Mailing Address - Street 2:#110
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5006
Mailing Address - Country:US
Mailing Address - Phone:949-495-9056
Mailing Address - Fax:949-363-0206
Practice Address - Street 1:30101 TOWN CENTER DR
Practice Address - Street 2:#110
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5006
Practice Address - Country:US
Practice Address - Phone:949-495-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT22289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist