MEDICARE: LISA DEBENEDETTO L.M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT42565	CA

General Provider Information

NPI Number	:	1447304647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA DEBENEDETTO L.M.F.T.

Provider Business Mailing Address
First Line	:	7025 N CHESTNUT AVE
Second Line	:	SUITE 103
City	:	FRESNO
State	:	CA
Zip	:	93720-0351
Country	:	US
Telephone Number	:	559-326-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	7025 N CHESTNUT AVE
Second Line	:	SUITE 103
City	:	FRESNO
State	:	CA
Zip	:	93720-0351
Country	:	US
Telephone Number	:	559-326-9021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/12/2010

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