Provider Demographics
NPI:1083192041
Name:QUINN, LISA MENAKER (LMFT, PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MENAKER
Last Name:QUINN
Suffix:
Gender:F
Credentials:LMFT, PSYD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:MENAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2345 E. COAST HIGHWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625
Mailing Address - Country:US
Mailing Address - Phone:949-292-6281
Mailing Address - Fax:
Practice Address - Street 1:2345 E. COAST HIGHWAY
Practice Address - Street 2:SUITE D
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625
Practice Address - Country:US
Practice Address - Phone:949-292-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist