Individual ProviderLisa Marie HernandezMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address2730 Wilshire Blvd Ste 650, Santa Monica, CA 90403-4746(424) 253-8824(818) 257-2405PECOS EnrollmentBased on the most recent information from CMS, provider Lisa Marie Hernandez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1457586984Provider TypeIndividualFull NameHernandez, Lisa MarieTitleMs.CredentialMAGenderFemaleSole ProprietorYesEnumeration Date5/28/2009Last Updated2/19/2021Contact InformationPractice LocationPractice Address2730 Wilshire Blvd Ste 650, Santa Monica, CA 90403-4746Phone(424) 253-8824Fax(424) 389-7572Mailing LocationMailing Address3836 Overland Ave Unit 5, Culver City, CA 90232-3367Phone(818) 257-2405Fax(424) 389-7572Provider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseMFT79612CaliforniaCode106H00000XDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense79612California