Provider Demographics
NPI:1700960457
Name:FOSTER, RISA MARILYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RISA
Middle Name:MARILYN
Last Name:FOSTER
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 1:4040 MOORPARK AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117
Mailing Address - Country:US
Mailing Address - Phone:408-248-0788
Mailing Address - Fax:408-248-0790
Practice Address - Street 1:4040 MOORPARK AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117
Practice Address - Country:US
Practice Address - Phone:408-248-0788
Practice Address - Fax:408-248-0790
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS60461041C0700X
CAMFT17317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ79138ZMedicare ID - Type Unspecified