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General NPI Number Information
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NPI Number | 1508155367
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Entity Type | Individual
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Provider Name | LISA MARIE KREKLER LCSW, DSW
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Gender | Female
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 3017 TELEGRAPH AVE STE 210
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City | BERKELEY
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State | CA
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Zip | 94705
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Country | US
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Telephone | 760-237-8112
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Fax | 760-330-2108
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Provider Business Mailing Address
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Address Line | 960 POSTAL WAY UNIT 2996
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City | VISTA
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State | CA
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Zip | 92085-7121
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Country | US
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Telephone | 760-237-8112
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Fax | 760-330-2108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 25734
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License Number State | CA
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