Provider Demographics
NPI:1154850873
Name:SIENKIEWICZ, LISA MARIE (LMFT #132386)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SIENKIEWICZ
Suffix:
Gender:F
Credentials:LMFT #132386
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 EVERGREEN LOOP
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-8477
Mailing Address - Country:US
Mailing Address - Phone:714-349-9328
Mailing Address - Fax:
Practice Address - Street 1:4160 TEMESCAL CANYON RD STE 205
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-4624
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132386106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist