Provider Demographics
NPI:1457458028
Name:SAUNDERS, IRENE LISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:LISA
Last Name:SAUNDERS
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 1:5409 RENAISSANCE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5635
Mailing Address - Country:US
Mailing Address - Phone:858-202-1624
Mailing Address - Fax:
Practice Address - Street 1:7730 HERSCHEL AVE
Practice Address - Street 2:SUITE H
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4432
Practice Address - Country:US
Practice Address - Phone:858-202-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS124761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical