Provider Demographics
NPI:1699146589
Name:MERKEL, LISSA (LCSW, LAADC)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name:MERKEL
Suffix:
Gender:F
Credentials:LCSW, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 WATSEKA AVE
Mailing Address - Street 2:APT 104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7901
Mailing Address - Country:US
Mailing Address - Phone:310-925-9510
Mailing Address - Fax:
Practice Address - Street 1:3727 WATSEKA AVE
Practice Address - Street 2:APT 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-7901
Practice Address - Country:US
Practice Address - Phone:310-925-9510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW829911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical