Provider Demographics
NPI:1780719526
Name:LISKIN, AHAB (LCSW)
Entity type:Individual
Prefix:
First Name:AHAB
Middle Name:
Last Name:LISKIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DAMIEN
Other - Middle Name:MICHAEL AHAB
Other - Last Name:LISKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:648 S RIDGELEY DR APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3824
Mailing Address - Country:US
Mailing Address - Phone:323-933-2988
Mailing Address - Fax:
Practice Address - Street 1:1424 4TH ST STE 303
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2360
Practice Address - Country:US
Practice Address - Phone:310-393-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS198911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW19891Medicare ID - Type Unspecified