DR. LELAND VANDENDALE (NPI# 1609309103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609309103 |
| Entity Type | Individual |
| Full Name | DR. LELAND VANDENDALE |
| Other Name | LELAND VAN DEN DAELE |
| Credential | PHD |
| Practice Address |
7 4th St Petaluma CA 94952-3043 |
| Mailing Address |
4480 Fairway Dr Rohnert Park CA 94928-1440 |
| Practice Telephone | 4153594117 |
| Mailing Telephone | 4153594117 |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2019-05-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0700X |
Psychologist Specialization: Adult Development & Aging |
PSY 9210 | CA | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY 9210 | CA | Behavioral Health & Social Service Providers |
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
PSY 9210 | CA | Behavioral Health & Social Service Providers |
| N | 102L00000X | Psychoanalyst | PSY 9210 | CA | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7 4th St, Petaluma, CA 949523043 | 4153594117 |
| Street Address |
7 4TH ST |
| City | PETALUMA |
| State | CA |
| Zip Code | 94952-3043 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649342700 | Robert J Dalzell | Marriage & Family Therapist | 7 4th St, Suite 10, Petaluma, CA 94952-3043 | 2006-11-14 |
| 1215472030 | Seeds of Awareness, Inc | Community/Behavioral Health | 7 4th St, Suite 46, Petaluma, CA 94952-3043 | 2017-01-03 |
| 1265809180 | Lana Reuter | Marriage & Family Therapist | 7 4th St, Suite 12, Petaluma, CA 94952-3043 | 2015-08-26 |
| 1174935050 | Denise Segerman Safont | Marriage & Family Therapist | 7 4th St, Petaluma, CA 94952-3043 | 2014-05-27 |
| 1245652585 | Nicole Renae | Counselor | 7 4th St, Suite 49, Petaluma, CA 94952-3043 | 2014-01-06 |
| 1023307766 | Tracy D Thiem | Psychologist | 7 4th St, Suite 7, Petaluma, CA 94952-3043 | 2011-04-04 |
| 1851697452 | Ona Kathryn Goodrich | Acupuncturist | 7 4th St, Suite 44, Petaluma, CA 94952-3043 | 2011-01-31 |
| 1508070731 | Joanna Andrea Pashdag | Psychologist | 7 4th St, Suite 13, Petaluma, CA 94952-3043 | 2007-05-09 |
| 1861536187 | Victoria White | Marriage & Family Therapist | 7 4th St, Suite 18, Petaluma, CA 94952-3043 | 2007-02-19 |
| 1760538896 | Laura J.s. Kellison | Psychologist | 7 4th St, Suites 32 and 33, Petaluma, CA 94952-3043 | 2007-01-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114587680 | Benjamin R Idarius | Behavior Technician | 101 H St. Ste. L, Petaluma, CA 94952 | 2019-06-17 |
| 1518457159 | Kyleen Joan Romero | Behavioral Analyst | 25 Graylawn Ave, Petaluma, CA 94952 | 2018-05-17 |
| 1437647526 | John Scruggs | Behavior Technician | 301 H St. Suit L, Petaluma, CA 94952 | 2018-04-25 |
| 1811404684 | Brief and Strategic Counseling Service | Counselor | 843 Chardonnay Cir., Petaluma, CA 94952 | 2018-01-03 |
| 1730638396 | Jennifer Lee Sloan | Acupuncturist | 517 Hayes Lane, Petaluma, CA 94952 | 2016-09-23 |
| 1982057295 | Elene Hwa-yihg Chung | Acupuncturist | 130 Graylawn Ave.,#f, Petaluma, CA 94952 | 2016-07-21 |
| 1457773624 | Lisa Hirsch Cordeiro | Marriage & Family Therapist | 700 Sixth Street, Petaluma, CA 94952 | 2014-01-07 |
| 1811271075 | Jacques Philippe Archer | Massage Therapist | 131b Kentucky St., Petaluma, CA 94952 | 2011-10-06 |
| 1477841609 | Karna Licia Dawson | Social Worker | 205 Keller St., Petaluma, CA 94952 | 2011-07-21 |
| 1497051783 | Melissa Beth Wilson | Acupuncturist | 155a Kentucky Street, Petaluma, CA 94952 | 2011-02-03 |
| Find all providers in zip 94952 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821555210 | Brenda Mckinley, Psyd, Psychological Services Incorporated | Psychologist | 7 4th St Ste 19, Petaluma, CA 94952-3072 | 2019-02-21 |
| 1043651722 | Kaitlin Marie Venema | Psychologist | 1900 S Mcdowell Blvd, Petaluma, CA 94954-5473 | 2013-07-10 |
| 1760637607 | Richard Carolan | Psychologist | 7 4th Street, Suite 29, Petaluma, CA 94952 | 2008-11-19 |
| 1003993239 | Annette A Strack | Psychologist | 318 Western Ave, Petaluma, CA 94952-2919 | 2006-11-01 |
| 1144265851 | Julia Winston Melody | Psychologist | 523 Hayes Ln, Petaluma, CA 94952-4011 | 2006-06-17 |
| 1649210691 | Richard Steven Lesch | Psychologist | 222 Weller St, Petaluma, CA 94952-3183 | 2006-06-07 |
| 1316476328 | Christopher John Barr | Psychologist | 11207 Valley Ford Rd, Petaluma, CA 94952-3700 | 2017-06-05 |
| 1164805784 | Amanda Bernice Eyges Spencer | Psychologist | 1900 S Mcdowell Blvd, Petaluma, CA 94954-5473 | 2015-07-01 |
| 1023307766 | Tracy D Thiem | Psychologist | 7 4th St, Suite 7, Petaluma, CA 94952-3043 | 2011-04-04 |
| 1154628634 | Laura Kellison, Psy,.d. | Psychologist | 115 Liberty St, Suite 4, Petaluma, CA 94952-2326 | 2011-02-18 |
| Find all providers in PETALUMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.