Provider Demographics
NPI:1578770228
Name:LASATER, LINDA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LEE
Last Name:LASATER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 S SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4650
Mailing Address - Country:US
Mailing Address - Phone:323-653-5167
Mailing Address - Fax:323-650-1230
Practice Address - Street 1:566 S SAN VICENTE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4650
Practice Address - Country:US
Practice Address - Phone:323-653-5167
Practice Address - Fax:323-650-1230
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11477103TC0700X, 103TP0814X
CAMFT20187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11477Medicare UPIN