Provider Demographics
NPI:1932451804
Name:LEHMAN, ELLEN JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:JAY
Last Name:LEHMAN
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 1:1132 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4621
Mailing Address - Country:US
Mailing Address - Phone:310-393-0800
Mailing Address - Fax:310-828-2930
Practice Address - Street 1:1132 26TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4621
Practice Address - Country:US
Practice Address - Phone:310-393-0800
Practice Address - Fax:310-828-2930
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAK602 CA4869103T00000X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst