Provider Demographics
NPI:1699133439
Name:FELDMAN, LISA (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FELDMAN
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 1:2261 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-2533
Mailing Address - Country:US
Mailing Address - Phone:310-402-3131
Mailing Address - Fax:
Practice Address - Street 1:9250 WILSHIRE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3352
Practice Address - Country:US
Practice Address - Phone:310-402-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist