Provider Demographics
NPI:1699051862
Name:EATON, LISA M (MSW, LSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:EATON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26741 PORTOLA PKWY STE 1E
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1763
Mailing Address - Country:US
Mailing Address - Phone:949-236-1990
Mailing Address - Fax:
Practice Address - Street 1:3014 LUPINE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8439
Practice Address - Country:US
Practice Address - Phone:949-236-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013267104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker