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General NPI Number Information
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NPI Number | 1053612705
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Entity Type | Individual
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Provider Name | ELIZA LEHRKE PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 919 SIR FRANCIS DRAKE BLVD
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City | KENTFIELD
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State | CA
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Zip | 94904-1535
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 919 SIR FRANCIS DRAKE BLVD. SUITE 201C
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City | KENTFIELD
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State | CA
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Zip | 94904
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Country | US
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Telephone |
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Fax |
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 32677
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32677
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License Number State | CA
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