Provider Demographics
NPI:1265504807
Name:WALDMAN, LISA (LC S W, MPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:LC S W, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N BEDFORD DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5129
Mailing Address - Country:US
Mailing Address - Phone:310-275-6545
Mailing Address - Fax:310-275-6545
Practice Address - Street 1:360 N BEDFORD DR
Practice Address - Street 2:SUITE 312
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5129
Practice Address - Country:US
Practice Address - Phone:310-275-6545
Practice Address - Fax:310-275-6545
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS132021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW13202Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID