Healthcare Provider Details

I. General information

NPI: 1508155367
Provider Name (Legal Business Name): LISA MARIE KREKLER LCSW, DSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 EL CAMINO REAL STE C
CARLSBAD CA
92008-2110
US

IV. Provider business mailing address

3150 EL CAMINO REAL STE C
CARLSBAD CA
92008-2110
US

V. Phone/Fax

Practice location:
  • Phone: 760-502-6500
  • Fax: 760-502-6500
Mailing address:
  • Phone: 760-502-6500
  • Fax: 760-502-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9404
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5060
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 25734
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL12733
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: