Provider Demographics
NPI:1669013140
Name:WARNER, LISA RUTH (LCSW 26925)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RUTH
Last Name:WARNER
Suffix:
Gender:F
Credentials:LCSW 26925
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95009-0032
Mailing Address - Country:US
Mailing Address - Phone:650-773-8587
Mailing Address - Fax:
Practice Address - Street 1:1885 THE ALAMEDA STE 131
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1700
Practice Address - Country:US
Practice Address - Phone:650-773-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical