Healthcare Provider Details

I. General information

NPI: 1770818981
Provider Name (Legal Business Name): PAMELA LYSS-LERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S BEMISTON AVE STE 1213
CLAYTON MO
63105-1907
US

IV. Provider business mailing address

230 S BEMISTON AVE STE 1213
CLAYTON MO
63105-1907
US

V. Phone/Fax

Practice location:
  • Phone: 415-820-1477
  • Fax: 415-820-1599
Mailing address:
  • Phone: 415-820-1477
  • Fax: 415-820-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA108806
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2022016652
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: