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Contact Information

BRODERICK LEAKS, PHD
595 E COLORADO BLVD
SUITE 708
PASADENA, CA91101-2039
 Phone: 626-421-8956
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BRODERICK LEAKS · (Male)

NPI # 1649565102
Status Active
Credentials PHD
Entity Individual
Enumeration date 06/13/2011
Last updated 06/13/2011 - About 15 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # PSY 24273
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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