Provider Demographics
NPI:1669502928
Name:LEMERT, REBECCA G
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:LEMERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23822 VALENCIA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5344
Mailing Address - Country:US
Mailing Address - Phone:310-853-2828
Mailing Address - Fax:
Practice Address - Street 1:8550 BALBOA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3579
Practice Address - Country:US
Practice Address - Phone:310-853-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist