Provider Demographics
NPI:1073667283
Name:STRUB, LISA ANN (LICSW/LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:STRUB
Suffix:
Gender:F
Credentials:LICSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4957 LAKEMONT BLVD SE # C4-131
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-7801
Mailing Address - Country:US
Mailing Address - Phone:303-882-9095
Mailing Address - Fax:
Practice Address - Street 1:4957 LAKEMONT BLVD SE STE C4-131
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-7801
Practice Address - Country:US
Practice Address - Phone:206-659-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW612535601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical