Provider Demographics
NPI:1568097996
Name:RAMOS, LISA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:RAMOS
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 1:1200 AVIATION BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4059
Mailing Address - Country:US
Mailing Address - Phone:310-376-2468
Mailing Address - Fax:310-376-6068
Practice Address - Street 1:1200 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4064
Practice Address - Country:US
Practice Address - Phone:310-376-2468
Practice Address - Fax:310-376-6068
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist