Provider Demographics
NPI:1609674233
Name:NEW LEAF THERAPY MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NEW LEAF THERAPY MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVEH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-261-7785
Mailing Address - Street 1:1661 HARVEY MILK ST APT 516
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3789
Mailing Address - Country:US
Mailing Address - Phone:619-261-7785
Mailing Address - Fax:
Practice Address - Street 1:1661 HARVEY MILK ST APT 516
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3789
Practice Address - Country:US
Practice Address - Phone:619-261-7785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty