Lisa Deanne Waldman, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY18493 Issued in CA

Practice address

2615 Pacific Coast Hwy
Suite 325
Hermosa Beach, CA 90254-2225

Phone

(310) 528-5550

Fax

(310) 521-6411

NPI assigned

Jun 21, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371772800000",
    "number": "1285073320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 PACIFIC COAST HWY",
            "address_2": "SUITE 325",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902542225",
            "telephone_number": "310-528-5550",
            "fax_number": "310-521-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 PACIFIC COAST HWY",
            "address_2": "SUITE 325",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902542225",
            "telephone_number": "310-528-5550",
            "fax_number": "310-521-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDMAN",
        "first_name": "LISA",
        "middle_name": "DEANNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY18493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Vu, B.F.A., BCABA
• Joanna Vuong, O.D.
• Vy Pham OD Inc.
• Kelly Condon Waggoner, PSY.D.
• Danielle Wagoner, MA, BCBA
• Kacey Walker, AMFT
• Mignon Walker, MD
• Steven V Walker Jr., APCC
• Jennifer Patricia Walsh, ED.D
• Kelly Warren, PSYD

• Clinical Neuropsychologist in Hermosa Beach, CA
• Providers in Hermosa Beach, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.