Provider Demographics
NPI:1588549968
Name:KIM-FISHER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KIM-FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2046 ALTAMONT RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1307
Mailing Address - Country:US
Mailing Address - Phone:818-642-2917
Mailing Address - Fax:
Practice Address - Street 1:2046 ALTAMONT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94578-1307
Practice Address - Country:US
Practice Address - Phone:818-642-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist