Healthcare Provider Details

I. General information

NPI: 1760544597
Provider Name (Legal Business Name): LISA CAROL SPARS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 ENTERPRISE DR BLDG 2 # MS 2-270
FAIRFIELD CA
94533-5801
US

IV. Provider business mailing address

1148 ARLINGTON WAY
MARTINEZ CA
94553-2322
US

V. Phone/Fax

Practice location:
  • Phone: 707-399-4948
  • Fax: 707-399-4957
Mailing address:
  • Phone: 925-457-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: