Provider Demographics
NPI:1881985794
Name:KANTOR, LISA DANIELLE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DANIELLE
Last Name:KANTOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 WOODBINE ST.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1831
Mailing Address - Country:US
Mailing Address - Phone:310-625-0759
Mailing Address - Fax:
Practice Address - Street 1:12500 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1831
Practice Address - Country:US
Practice Address - Phone:310-625-0759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48263106H00000X
CAMFC 42863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist