Provider Demographics
NPI:1679646699
Name:MARIE, LISA A (PHD, MA)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:MARIE
Suffix:
Gender:F
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 RICHMOND RD SPC 60
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1060
Mailing Address - Country:US
Mailing Address - Phone:805-223-0267
Mailing Address - Fax:
Practice Address - Street 1:5740 RALSTON ST STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7847
Practice Address - Country:US
Practice Address - Phone:805-289-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist