Provider Demographics
NPI:1447274881
Name:LACTER, ELLEN PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:PATRICIA
Last Name:LACTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4002
Mailing Address - Country:US
Mailing Address - Phone:619-584-7737
Mailing Address - Fax:858-549-4202
Practice Address - Street 1:3505 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4002
Practice Address - Country:US
Practice Address - Phone:619-584-7737
Practice Address - Fax:858-549-4202
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9382103T00000X
CAMFC17912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA076585OtherMANAGED HEALTH NETWORK
CAPR0093820Medicaid
CACP9382Medicare ID - Type Unspecified