Provider Demographics
NPI:1720041239
Name:LICHMAN, JEANNE MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:MARY
Last Name:LICHMAN
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 1:1439 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2228
Mailing Address - Country:US
Mailing Address - Phone:714-633-6237
Mailing Address - Fax:714-990-1959
Practice Address - Street 1:1439 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2228
Practice Address - Country:US
Practice Address - Phone:714-633-6237
Practice Address - Fax:714-990-1959
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14165103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA135513FCOtherPREFERRED CARE
CAOPL141650OtherBLUE SHIELD
CAPSY14165OtherPSYCHOLOGY LICENSE
CA542200PL141650OtherBLUE CROSS BLUE SHIELD
CA61-37787OtherUS BEHAVIORAL HEALTH