Provider Demographics
NPI:1316514722
Name:NEWMAN, LISA DANEEN
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DANEEN
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13953 PANAY WAY APT 421
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4100
Mailing Address - Country:US
Mailing Address - Phone:310-218-8758
Mailing Address - Fax:424-228-5628
Practice Address - Street 1:2615 PACIFIC COAST HWY STE 217
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2229
Practice Address - Country:US
Practice Address - Phone:310-218-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist