Healthcare Provider Details

I. General information

NPI: 1699051862
Provider Name (Legal Business Name): LISA M EATON MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26632 TOWNE CENTRE DR STE 300-4016
FOOTHILL RANCH CA
92610-2813
US

IV. Provider business mailing address

26632 TOWNE CENTRE DR STE 300-4016
FOOTHILL RANCH CA
92610-2813
US

V. Phone/Fax

Practice location:
  • Phone: 949-236-1990
  • Fax:
Mailing address:
  • Phone: 949-236-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150013267
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: