Provider Demographics
NPI:1538904511
Name:ACKER, LISA H (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:H
Last Name:ACKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 19TH ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-5363
Mailing Address - Country:US
Mailing Address - Phone:917-242-7280
Mailing Address - Fax:
Practice Address - Street 1:1927 19TH ST UNIT C
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-5363
Practice Address - Country:US
Practice Address - Phone:917-242-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4460103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral