Provider Demographics
NPI:1730218819
Name:MONACO-RUSS, LISA (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:MONACO-RUSS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21304 BEACH BLVD # U105
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5496
Mailing Address - Country:US
Mailing Address - Phone:716-341-5151
Mailing Address - Fax:
Practice Address - Street 1:21304 BEACH BLVD # U105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5496
Practice Address - Country:US
Practice Address - Phone:716-341-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035963-1101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health