Provider Demographics
NPI:1356954150
Name:CRISWELL, LISA ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:CRISWELL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4946 E YALE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1571
Mailing Address - Country:US
Mailing Address - Phone:559-458-0210
Mailing Address - Fax:
Practice Address - Street 1:4946 E YALE AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1571
Practice Address - Country:US
Practice Address - Phone:619-245-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96494101YM0800X, 104100000X
104100000X
CA1180161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker