Healthcare Provider Details

I. General information

NPI: 1902073398
Provider Name (Legal Business Name): LISA BARNES LAINER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 OVERLAND AVE SUITE 500B
LOS ANGELES CA
90064-3366
US

IV. Provider business mailing address

2566 OVERLAND AVE STE 780
LOS ANGELES CA
90064-3371
US

V. Phone/Fax

Practice location:
  • Phone: 310-967-5041
  • Fax: 310-204-5721
Mailing address:
  • Phone: 424-744-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY14680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1098
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3492
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: