=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467572065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA F SANTAMARIA LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 01/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7600 E GRAVES AVE
-----------------------------------------------------
City | ROSEMEAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91770-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-280-6510
-----------------------------------------------------
Fax | 626-288-1026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7600 E GRAVES AVE
-----------------------------------------------------
City | ROSEMEAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91770-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-280-6510
-----------------------------------------------------
Fax | 626-288-1026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MFC 40329
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC 40329
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------