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NPI Code Detail

MEDICARE: LISA RENA WILLIAMS

MEDICARE: LISA RENA WILLIAMS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1619701646
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA RENA WILLIAMS
Provider Business Mailing Address
First Line : PO BOX 228
Second Line :
City : ROUND MOUNTAIN
State : CA
Zip : 96084-0228
Country : US
Telephone Number : 530-337-6263
Fax Number :
Provider Business Practice Location Address
First Line : 29632 E HIGHWAY 299
Second Line :
City : ROUND MOUNTAIN
State : CA
Zip : 96084-8000
Country : US
Telephone Number : 530-337-6263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2024
Last Update Date : 08/30/2024

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