Provider Demographics
NPI:1174702716
Name:BERNER, LESLIE WAYNE
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:WAYNE
Last Name:BERNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 21ST ST
Mailing Address - Street 2:205
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5220
Mailing Address - Country:US
Mailing Address - Phone:916-441-0123
Mailing Address - Fax:916-441-6893
Practice Address - Street 1:1507 21ST ST
Practice Address - Street 2:205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5220
Practice Address - Country:US
Practice Address - Phone:916-441-0123
Practice Address - Fax:916-441-6893
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health