Provider Demographics
NPI:1881031458
Name:GLASS, LEILA (PHD)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LEILA
Other - Middle Name:
Other - Last Name:GLASS DIFELICIANTONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:9401 WILSHIRE BLVD STE 730
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2946
Mailing Address - Country:US
Mailing Address - Phone:310-273-2701
Mailing Address - Fax:310-273-1127
Practice Address - Street 1:9401 WILSHIRE BLVD STE 730
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2946
Practice Address - Country:US
Practice Address - Phone:310-273-2701
Practice Address - Fax:310-273-1127
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA30698103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program