Provider Demographics
NPI:1588659080
Name:GRAFF-MARSH, LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GRAFF-MARSH
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 1:4985 PARK RIM DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-1721
Mailing Address - Country:US
Mailing Address - Phone:858-272-9812
Mailing Address - Fax:858-272-9812
Practice Address - Street 1:4985 PARK RIM DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-1721
Practice Address - Country:US
Practice Address - Phone:858-272-9812
Practice Address - Fax:858-272-9812
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 160771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS160770OtherBLUE SHIELD
CALCS160770OtherBLUE SHIELD
CA753187460OtherEIN #
CASW16077Medicare PIN