Provider Demographics
NPI:1376185868
Name:SWEDLOW, LISA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SWEDLOW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1364
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0364
Mailing Address - Country:US
Mailing Address - Phone:661-900-5145
Mailing Address - Fax:
Practice Address - Street 1:208 LUGONIA ST APT B
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-1852
Practice Address - Country:US
Practice Address - Phone:661-900-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist