Provider Demographics
NPI:1326437088
Name:MARIN, LISA (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 NE TROON DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1988
Mailing Address - Country:US
Mailing Address - Phone:816-200-0515
Mailing Address - Fax:
Practice Address - Street 1:3721 NE TROON DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1988
Practice Address - Country:US
Practice Address - Phone:816-200-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2025-09-09
Deactivation Date:2024-04-11
Deactivation Code:
Reactivation Date:2025-08-26
Provider Licenses
StateLicense IDTaxonomies
MO20250251461041C0700X
KS131291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical