Provider Demographics
NPI:1023251501
Name:LICHTER, ROBERTA (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:LICHTER
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 VENTURA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2914
Mailing Address - Country:US
Mailing Address - Phone:818-515-8097
Mailing Address - Fax:818-780-8381
Practice Address - Street 1:14318 MARTHA ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91401-4618
Practice Address - Country:US
Practice Address - Phone:818-515-8097
Practice Address - Fax:818-780-8381
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical