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General NPI Number Information
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NPI Number | 1023251501
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Entity Type | Individual
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Provider Name | ROBERTA LICHTER PSYCHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 14318 MARTHA ST
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City | SHERMAN OAKS
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State | CA
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Zip | 91401-4618
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Country | US
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Telephone | 818-515-8097
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Fax | 818-780-8381
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Provider Business Mailing Address
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Address Line | 15720 VENTURA BLVD SUITE 210
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City | ENCINO
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State | CA
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Zip | 91436-2914
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Country | US
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Telephone | 818-515-8097
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Fax | 818-780-8381
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY10657
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License Number State | CA
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