Basic Information
| Provider Information | |||||||||
| NPI: | 1508954280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEBOVITS | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3142 VISTA WAY | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607581480 | ||||||||
| FaxNumber: | 7604359472 | ||||||||
| Practice Location | |||||||||
| Address1: | 3142 VISTA WAY | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607581480 | ||||||||
| FaxNumber: | 7604359472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.