Provider Demographics
NPI:1669137287
Name:WHITMORE, LISA ROBIN (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROBIN
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 DE LA CRUZ BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2452
Mailing Address - Country:US
Mailing Address - Phone:408-350-3278
Mailing Address - Fax:855-965-0953
Practice Address - Street 1:3100 DE LA CRUZ BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-2452
Practice Address - Country:US
Practice Address - Phone:408-350-3278
Practice Address - Fax:855-965-0953
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87433104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker