Provider Demographics
NPI:1184214017
Name:MONTAGNA, LISA (CADC-III)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MONTAGNA
Suffix:
Gender:F
Credentials:CADC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032
Mailing Address - Country:US
Mailing Address - Phone:213-625-5009
Mailing Address - Fax:213-625-5025
Practice Address - Street 1:3217 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032
Practice Address - Country:US
Practice Address - Phone:213-625-5009
Practice Address - Fax:213-625-5025
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0001110820101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)