Healthcare Provider Details

I. General information

NPI: 1811022775
Provider Name (Legal Business Name): LIZA BATHORI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIZA STEVENS PSY.D.

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S WINCHESTER BLVD SUITE C-120
SAN JOSE CA
95128-3901
US

IV. Provider business mailing address

467 HAMILTON AVE SUITE 22
PALO ALTO CA
94301-1830
US

V. Phone/Fax

Practice location:
  • Phone: 408-654-9311
  • Fax:
Mailing address:
  • Phone: 650-323-1676
  • Fax: 650-323-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY#20160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: