Provider Demographics
NPI:1629149174
Name:FREEARK, LISA LOUISE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LOUISE
Last Name:FREEARK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 DALY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3309
Mailing Address - Country:US
Mailing Address - Phone:323-226-4448
Mailing Address - Fax:
Practice Address - Street 1:1925 DALY ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3309
Practice Address - Country:US
Practice Address - Phone:323-226-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical