Healthcare Provider Details

I. General information

NPI: 1538095203
Provider Name (Legal Business Name): LUCY KARINA RAISANI MA STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S PRIMROSE AVE
MONROVIA CA
91016-2856
US

IV. Provider business mailing address

202 S SUNSET CANYON DR
BURBANK CA
91501-1103
US

V. Phone/Fax

Practice location:
  • Phone: 310-600-1354
  • Fax:
Mailing address:
  • Phone: 310-600-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberINTERN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: