MEDICARE: MS. LISA MARIE BROTT 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
1	1041C0700X	Clinical Social Worker	LCS 16870	CA

General Provider Information

NPI Number	:	1770607897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MARIE BROTT LCSW

Provider Business Mailing Address
First Line	:	5550 N FIGARDEN DR APT 119
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-3863
Country	:	US
Telephone Number	:	559-493-8003
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 W CLINTON AVE BLDG W & A
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-4206
Country	:	US
Telephone Number	:	559-264-7521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	03/19/2024

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