Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY9995 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY9995 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY9995 | CA |
NPI | 1104139302 |
---|---|
Provider Name | Dr. Cheryl Blanche Lanktree |
First Address | Santa Monica, CA 90403-5011 |
Second Address | Santa Monica, CA 90403-5011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2010 |
Last Update Date | 16/07/2010 |