MEDICARE: DR. ELLEN JAY LEHMAN PH.D.

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	AK602 CA4869	CA
2	102L00000X	Psychoanalyst	AK602 CA4869	CA

General Provider Information

NPI Number	:	1932451804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN JAY LEHMAN PH.D.

Provider Business Mailing Address
First Line	:	1132 26TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4621
Country	:	US
Telephone Number	:	310-393-0800
Fax Number	:	310-828-2930

Provider Business Practice Location Address
First Line	:	1132 26TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4621
Country	:	US
Telephone Number	:	310-393-0800
Fax Number	:	310-828-2930

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

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	10/02/2012

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