Provider Demographics
NPI:1932359429
Name:NEIMARK-GIZARA, LAURA LYNN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:NEIMARK-GIZARA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:PETTERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3674
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-3674
Mailing Address - Country:US
Mailing Address - Phone:530-416-9444
Mailing Address - Fax:
Practice Address - Street 1:938 LIGHTHOUSE WAY
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-3511
Practice Address - Country:US
Practice Address - Phone:530-416-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA682901041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker