Provider Demographics
NPI:1821761248
Name:WEINER, LISA ANN (MFT, PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:WEINER
Suffix:
Gender:F
Credentials:MFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 TERRACE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4017
Mailing Address - Country:US
Mailing Address - Phone:818-419-3600
Mailing Address - Fax:
Practice Address - Street 1:435 N BEDFORD DR STE 304
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4349
Practice Address - Country:US
Practice Address - Phone:818-419-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health