Healthcare Provider Details

I. General information

NPI: 1821761248
Provider Name (Legal Business Name): LISA ANN WEINER MFT, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N BEDFORD DR STE 304
BEVERLY HILLS CA
90210-4349
US

IV. Provider business mailing address

3511 TERRACE VIEW DR
ENCINO CA
91436-4017
US

V. Phone/Fax

Practice location:
  • Phone: 818-419-3600
  • Fax:
Mailing address:
  • Phone: 818-419-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number48555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: