Provider Demographics
NPI:1518074996
Name:BAKER, LISA MICHELE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHELE
Last Name:BAKER
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 1:12966 EUCLID ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5200
Mailing Address - Country:US
Mailing Address - Phone:714-823-4770
Mailing Address - Fax:714-823-4777
Practice Address - Street 1:12966 EUCLID ST
Practice Address - Street 2:SUITE 280
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5200
Practice Address - Country:US
Practice Address - Phone:714-823-4770
Practice Address - Fax:714-823-4777
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS210411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical