Provider Demographics
NPI:1760277354
Name:SAMRAD, LEILA (LMFT)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:SAMRAD
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 BRIDGEWAY STE 242
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-3801
Mailing Address - Country:US
Mailing Address - Phone:415-336-6670
Mailing Address - Fax:
Practice Address - Street 1:3030 BRIDGEWAY STE 242
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-3801
Practice Address - Country:US
Practice Address - Phone:415-336-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist