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NPI Code Detail

MEDICARE: MRS. LISA VICTORIA PATERNOSTER LCP

MEDICARE: MRS. LISA VICTORIA PATERNOSTER LCP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLPC-3392ID

General Provider Information

NPI Number : 1033388236
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA VICTORIA PATERNOSTER LCP
Provider Business Mailing Address
First Line : 3098 N FIVE MILE RD
Second Line :
City : BOISE
State : ID
Zip : 83713-5215
Country : US
Telephone Number : 208-376-4999
Fax Number :
Provider Business Practice Location Address
First Line : 3098 N FIVE MILE RD
Second Line :
City : BOISE
State : ID
Zip : 83713-5215
Country : US
Telephone Number : 208-376-4999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2008
Last Update Date : 02/21/2008

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Directions to “ MRS. LISA VICTORIA PATERNOSTER LCP” Practice Location

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