Provider Demographics
NPI:1811022775
Name:BATHORI, LIZA (PSYD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:BATHORI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:467 HAMILTON AVE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1830
Mailing Address - Country:US
Mailing Address - Phone:650-323-1676
Mailing Address - Fax:650-323-1277
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:SUITE C-120
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-654-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#20160103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEIN:94-3120231OtherEASTER SEALS BAY AREA