Provider Demographics
NPI:1528015526
Name:EDWARDS, LISA PITTENGER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:PITTENGER
Last Name:EDWARDS
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-3407
Mailing Address - Fax:510-204-3411
Practice Address - Street 1:3100 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:510-204-3407
Practice Address - Fax:510-204-3411
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA184031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical