Provider Demographics
NPI:1285073320
Name:WALDMAN, LISA DEANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:DEANNE
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:2615 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 325
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2225
Mailing Address - Country:US
Mailing Address - Phone:310-528-5550
Mailing Address - Fax:310-521-6411
Practice Address - Street 1:2615 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 325
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2225
Practice Address - Country:US
Practice Address - Phone:310-528-5550
Practice Address - Fax:310-521-6411
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY18493103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist