MEDICARE: DR. LISA CARMICHAEL KRUEGER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY12073	CA

General Provider Information

NPI Number	:	1215880372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA CARMICHAEL KRUEGER PHD

Provider Business Mailing Address
First Line	:	515 MADRE ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-5414
Country	:	US
Telephone Number	:	626-319-0432
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 MADRE ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-5414
Country	:	US
Telephone Number	:	626-319-0432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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