Provider Demographics
NPI:1902925035
Name:BALDWIN, LISA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BALDWIN
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:P.O. BOX 52374
Mailing Address - Street 2:LISA BALDWIN
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619
Mailing Address - Country:US
Mailing Address - Phone:949-224-3155
Mailing Address - Fax:949-427-3297
Practice Address - Street 1:4605 BARRANCA PKWY STE 101E
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1727
Practice Address - Country:US
Practice Address - Phone:194-922-4315
Practice Address - Fax:949-236-6426
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39972101YM0800X
CAMFC39972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty