MEDICARE: VIRGINIA LANCASTER LEP

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	103TS0200X	School Psychologist	LEP3597	CA

General Provider Information

NPI Number	:	1356894224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA LANCASTER LEP

Provider Business Mailing Address
First Line	:	530 S LAKE AVE # 197
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 S LAKE AVE # 197
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3515
Country	:	US
Telephone Number	:	626-671-0515
Fax Number	:

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

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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Directions to “ VIRGINIA LANCASTER LEP” Practice Location

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