Provider Demographics
NPI:1447462098
Name:FRIEDMAN, LISA JUDITH (MSW OTRL)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JUDITH
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MSW OTRL
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:J FRIEDMAN
Other - Last Name:ROELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW OTRL
Mailing Address - Street 1:1360 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5169
Mailing Address - Country:US
Mailing Address - Phone:520-991-3699
Mailing Address - Fax:
Practice Address - Street 1:1360 TIFFANY DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5169
Practice Address - Country:US
Practice Address - Phone:520-991-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0577225X00000X
CA15010225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15010OtherOT LICENSE
AZ0577OtherOT LICENSE