Provider Demographics
NPI:1881614782
Name:WINSLOW, LISA MARI (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARI
Last Name:WINSLOW
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 1:2220 SAINT GEORGE LN STE 2
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1307
Mailing Address - Country:US
Mailing Address - Phone:530-899-2800
Mailing Address - Fax:
Practice Address - Street 1:2220 SAINT GEORGE LN STE 2
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1307
Practice Address - Country:US
Practice Address - Phone:530-899-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW223220OtherMEDI-CAL PROVIDER NUMBER
CACSW223220OtherMEDI-CAL PROVIDER NUMBER