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General NPI Number Information
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NPI Number | 1336077650
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Entity Type | Organization
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Legal Business Name | SUSAN SCHMIDT-LACKNER A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/08/2026
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Last Update Date | 05/08/2026
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Provider Practice Location Address
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Address Line | 1239 S CAMDEN DR
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City | LOS ANGELES
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State | CA
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Zip | 90035-1111
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Country | US
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Telephone | 310-869-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 1239 S CAMDEN DR
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City | LOS ANGELES
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State | CA
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Zip | 90035-1111
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Country | US
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Telephone | 310-869-9119
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO, SECRETARY AND CFO,
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Name | SUSAN L SCHMIDT-LACKNER
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Credential | MD
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Telephone | 318-869-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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