Provider Demographics
NPI:1063926103
Name:BLAZIO, LISA ANTIONETTE (CATC I)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANTIONETTE
Last Name:BLAZIO
Suffix:
Gender:F
Credentials:CATC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 W CARSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6702
Mailing Address - Country:US
Mailing Address - Phone:310-787-1335
Mailing Address - Fax:562-987-4586
Practice Address - Street 1:3828 W CARSON ST STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6702
Practice Address - Country:US
Practice Address - Phone:310-787-1335
Practice Address - Fax:562-987-4586
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190077AHNMedicaid