Provider Demographics
NPI:1063716561
Name:GOLD, LISA ERIN (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ERIN
Last Name:GOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 N. MISSION ROAD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032
Mailing Address - Country:US
Mailing Address - Phone:323-221-1746
Mailing Address - Fax:323-221-5176
Practice Address - Street 1:4099 N. MISSION ROAD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032
Practice Address - Country:US
Practice Address - Phone:323-221-1746
Practice Address - Fax:323-221-5176
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW 284991041C0700X
CALCS628821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical