Provider Demographics
NPI:1619062197
Name:SALOPEK, LISA ANNE KOLBERG (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE KOLBERG
Last Name:SALOPEK
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 1:1 JOYA CT.
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8881
Mailing Address - Country:US
Mailing Address - Phone:505-660-0421
Mailing Address - Fax:
Practice Address - Street 1:1955 IRONWOOD AVE UNIT B
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1672
Practice Address - Country:US
Practice Address - Phone:505-660-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-39541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85300829Medicaid
NM85300829Medicaid