Healthcare Provider Details

I. General information

NPI: 1396574554
Provider Name (Legal Business Name): LISA NIGRO CAPPELLETTI PSY.D., PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13749 RIVERSIDE DR STE 100
SHERMAN OAKS CA
91423-2446
US

IV. Provider business mailing address

4648 LEMONA AVE
SHERMAN OAKS CA
91403-2427
US

V. Phone/Fax

Practice location:
  • Phone: 310-867-4454
  • Fax:
Mailing address:
  • Phone: 310-867-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15722
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY15722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: