Provider Demographics
NPI:1871680132
Name:WULKAN, LISA E (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:WULKAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18075 VENTURA BLVD
Mailing Address - Street 2:SUITE #224
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3517
Mailing Address - Country:US
Mailing Address - Phone:818-344-9819
Mailing Address - Fax:818-883-8053
Practice Address - Street 1:18075 VENTURA BLVD
Practice Address - Street 2:SUITE #224
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3517
Practice Address - Country:US
Practice Address - Phone:818-344-9819
Practice Address - Fax:818-883-8053
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS77381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical