Provider Demographics
NPI:1184215444
Name:SAFFO, LIZA O (LCSW)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:O
Last Name:SAFFO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14224 RIVERSIDE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2376
Mailing Address - Country:US
Mailing Address - Phone:917-580-1996
Mailing Address - Fax:
Practice Address - Street 1:683 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1639
Practice Address - Country:US
Practice Address - Phone:949-575-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
86-1011928OtherNOT INSURED
86-1011928OtherNO INSURANCE