Provider Demographics
NPI:1528775798
Name:BADAROU, LISA LEE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEE
Last Name:BADAROU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 MIRA LUNA
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1246
Mailing Address - Country:US
Mailing Address - Phone:909-419-0702
Mailing Address - Fax:
Practice Address - Street 1:16195 SISKIYOU RD STE 120B
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1346
Practice Address - Country:US
Practice Address - Phone:760-646-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical