Provider Demographics
NPI:1518737899
Name:KAMEN, LISA CYPERS
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CYPERS
Last Name:KAMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 VENTURA BLVD STE 639
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2717
Mailing Address - Country:US
Mailing Address - Phone:310-273-5300
Mailing Address - Fax:
Practice Address - Street 1:44670 MARGUERITE CT
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4831
Practice Address - Country:US
Practice Address - Phone:310-273-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36446101YA0400X
CA6139101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)