Provider Demographics
NPI:1225527567
Name:PADILLA, LISA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:PADILLA
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 1:4325 W SUNSET BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2180
Mailing Address - Country:US
Mailing Address - Phone:310-879-8004
Mailing Address - Fax:
Practice Address - Street 1:31290 CONGRESSIONAL DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3980
Practice Address - Country:US
Practice Address - Phone:616-633-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595171041C0700X
CA907571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty