Provider Demographics
NPI:1487720231
Name:STEIN, LISA SHARON (LMFT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:SHARON
Last Name:STEIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FOURTH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3072
Mailing Address - Country:US
Mailing Address - Phone:707-766-8567
Mailing Address - Fax:
Practice Address - Street 1:7 FOURTH ST STE 7
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3072
Practice Address - Country:US
Practice Address - Phone:707-766-8567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health