Provider Demographics
NPI:1093696866
Name:BLOHM, LISA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BLOHM
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 1:110 MARINER DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3716
Mailing Address - Country:US
Mailing Address - Phone:361-652-2728
Mailing Address - Fax:
Practice Address - Street 1:110 MARINER DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3716
Practice Address - Country:US
Practice Address - Phone:361-552-0261
Practice Address - Fax:361-552-8049
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX414621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty