Provider Demographics
NPI:1073846226
Name:DAVIDOVITZ, LISA MAREN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MAREN
Last Name:DAVIDOVITZ
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 1:1742 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4407
Mailing Address - Country:US
Mailing Address - Phone:415-734-7672
Mailing Address - Fax:
Practice Address - Street 1:1742 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4407
Practice Address - Country:US
Practice Address - Phone:415-734-7672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool