Provider Demographics
NPI:1689619181
Name:LANTZ, DOROTHY LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:LEE
Last Name:LANTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DELEE
Other - Middle Name:
Other - Last Name:LANTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:10 BRAUN CT
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1176
Mailing Address - Country:US
Mailing Address - Phone:415-331-5433
Mailing Address - Fax:415-331-5433
Practice Address - Street 1:2859 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2114
Practice Address - Country:US
Practice Address - Phone:415-331-5433
Practice Address - Fax:415-331-5433
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4953103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPL49530Medicare ID - Type Unspecified
CAOOPL49531Medicare ID - Type Unspecified