Active NPI
Lisa J Carmack
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1689010316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18813
- Practice address
- 3787 S Vermont Ave
Los Angeles, CA 90007-4203 - Phone
- (323) 373-2400
- Fax
- (323) 373-2402
- NPI assigned
- May 21, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18813 | CA | Primary |
Addresses
Primary practice location
3787 S Vermont Ave
Los Angeles, CA 90007-4203
Mailing address
3787 S Vermont Ave
Los Angeles, CA 90007-4203
Phone (323) 373-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18813 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369094400000",
"number": "1689010316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3787 S VERMONT AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900074203",
"telephone_number": "323-373-2400",
"fax_number": "323-373-2402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3787 S VERMONT AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900074203",
"telephone_number": "323-373-2400",
"fax_number": "323-373-2402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARMACK",
"first_name": "LISA",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-21",
"last_updated": "2013-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18813",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.