Healthcare Provider Details

I. General information

NPI: 1770607897
Provider Name (Legal Business Name): LISA MARIE BROTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE BLDG W & A
FRESNO CA
93705-4206
US

IV. Provider business mailing address

5550 N FIGARDEN DR APT 119
FRESNO CA
93722-3863
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax:
Mailing address:
  • Phone: 559-493-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 16870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: