Provider Demographics
NPI:1154107225
Name:COLORADO, LISABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:LISABETH
Middle Name:
Last Name:COLORADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12751 CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4817
Mailing Address - Country:US
Mailing Address - Phone:818-754-4571
Mailing Address - Fax:
Practice Address - Street 1:12751 CAMERON AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4817
Practice Address - Country:US
Practice Address - Phone:818-754-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist