Healthcare Provider Details

I. General information

NPI: 1871680132
Provider Name (Legal Business Name): LISA E. WULKAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18075 VENTURA BLVD SUITE #224
ENCINO CA
91316-3517
US

IV. Provider business mailing address

18075 VENTURA BLVD SUITE #224
ENCINO CA
91316-3517
US

V. Phone/Fax

Practice location:
  • Phone: 818-344-9819
  • Fax: 818-883-8053
Mailing address:
  • Phone: 818-344-9819
  • Fax: 818-883-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS7738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: