Provider Demographics
NPI:1922743418
Name:MATTHEWS, LISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4317 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3010
Mailing Address - Country:US
Mailing Address - Phone:562-719-3274
Mailing Address - Fax:
Practice Address - Street 1:4317 E 14TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3010
Practice Address - Country:US
Practice Address - Phone:562-719-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18894103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist