Provider Demographics
NPI:1558485714
Name:BONE, LISA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:BONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:17682 MITCHELL N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17682 MITCHELL N
Practice Address - Street 2:SUITE 104
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6046
Practice Address - Country:US
Practice Address - Phone:949-910-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA208356101OtherEIN