Provider Demographics
NPI:1215077730
Name:MARK, LOIS NORA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LOIS
Middle Name:NORA
Last Name:MARK
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 1:327 N SAN MATEO DR
Mailing Address - Street 2:STE 10
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2585
Mailing Address - Country:US
Mailing Address - Phone:650-344-5162
Mailing Address - Fax:510-865-3838
Practice Address - Street 1:327 N SAN MATEO DR
Practice Address - Street 2:STE 10
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2585
Practice Address - Country:US
Practice Address - Phone:650-344-5162
Practice Address - Fax:510-865-3838
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS6381041C0700X
CAMFC1356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist