Healthcare Provider Details

I. General information

NPI: 1124214580
Provider Name (Legal Business Name): LISA R HELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BEVERLY DR STE 212
BEVERLY HILLS CA
90212-4805
US

IV. Provider business mailing address

300 S BEVERLY DR STE 212
BEVERLY HILLS CA
90212-4805
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-1114
  • Fax:
Mailing address:
  • Phone: 310-826-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: