Provider Demographics
NPI:1457586984
Name:HERNANDEZ, LISA MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 OVERLAND AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3367
Mailing Address - Country:US
Mailing Address - Phone:818-257-2405
Mailing Address - Fax:424-389-7572
Practice Address - Street 1:2730 WILSHIRE BLVD STE 650
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4746
Practice Address - Country:US
Practice Address - Phone:424-253-8824
Practice Address - Fax:424-389-7572
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79612106H00000X
CAMFT79612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist