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General NPI Number Information
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NPI Number | 1427501105
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Entity Type | Organization
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Legal Business Name | PAULA DEFRISCO, LCSW
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 11549 LOS OSOS VALLEY RD SUITE 200
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-6471
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Country | US
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Telephone | 805-235-2800
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Fax | 805-439-2487
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Provider Business Mailing Address
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Address Line | 570 FUNSTON AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-5683
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Country | US
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Telephone | 805-235-2800
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Fax | 805-439-2487
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Authorized Official
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Title or Position | OWNER
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Name | PAULA DEFRISCO
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Credential | LCSW
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Telephone | 805-235-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCS27899
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License Number State | CA
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