Healthcare Provider Details

I. General information

NPI: 1679761167
Provider Name (Legal Business Name): LIA M PRUSHA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIA M SALCICCIA

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 OAK MEADOW DR
LOS GATOS CA
95032-4401
US

IV. Provider business mailing address

PO BOX 18878
SAN JOSE CA
95158-8878
US

V. Phone/Fax

Practice location:
  • Phone: 657-505-2079
  • Fax:
Mailing address:
  • Phone: 657-505-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number44647
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number44647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: