Healthcare Provider Details

I. General information

NPI: 1417513607
Provider Name (Legal Business Name): STACY PATRICIA HEISER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY PATRICIA LOMBARDO

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD
PASADENA CA
91101-6143
US

IV. Provider business mailing address

455 MARKET ST STE 1940
SAN FRANCISCO CA
94105-2448
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 650-613-5892
  • Fax: 650-934-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: