Healthcare Provider Details

I. General information

NPI: 1295272359
Provider Name (Legal Business Name): LISBETH CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 SHADELANDS DR BLDG 10
WALNUT CREEK CA
94598-2538
US

IV. Provider business mailing address

2730 SHADELANDS DR BLDG 10
WALNUT CREEK CA
94598-2538
US

V. Phone/Fax

Practice location:
  • Phone: 925-588-6073
  • Fax:
Mailing address:
  • Phone: 510-317-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: