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NPI Code Detail

MEDICARE: LISET CRISTINO CRESPIN LCSW

MEDICARE: LISET CRISTINO CRESPIN LCSW
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 WorkerLCSW67583CA

General Provider Information

NPI Number : 1659564532
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISET CRISTINO CRESPIN LCSW
Provider Business Mailing Address
First Line : 2500 WILSHIRE BLVD STE 500
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-4310
Country : US
Telephone Number : 323-290-4345
Fax Number : 213-388-1473
Provider Business Practice Location Address
First Line : 800 S SANTA ANITA AVE
Second Line :
City : ARCADIA
State : CA
Zip : 91006-3536
Country : US
Telephone Number : 626-254-5000
Fax Number : 626-577-4988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2007
Last Update Date : 12/01/2021

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