Basic Information
| Provider Information | |||||||||
| NPI: | 1366468985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LITE | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | KALLMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 DIAMOND GATE | ||||||||
| Address2: | |||||||||
| City: | ALISO VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926561978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493624403 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2414 N BROADWAY | ||||||||
| Address2: | #201 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900312359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 09/15/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY 12085 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 1041C0700X | LCS 9119 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.