MEDICARE: LISA BUCHWALD LANSING LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW18041	CA

General Provider Information

NPI Number	:	1508905316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BUCHWALD LANSING LCSW

Provider Business Mailing Address
First Line	:	2550 E FOOTHILL BLVD # D
Second Line	:	2ND FLOOR
City	:	PASADENA
State	:	CA
Zip	:	91107-3406
Country	:	US
Telephone Number	:	626-744-5230
Fax Number	:	626-744-5242

Provider Business Practice Location Address
First Line	:	2550 E FOOTHILL BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3406
Country	:	US
Telephone Number	:	626-744-5230
Fax Number	:	626-744-5242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	01/12/2022

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