MEDICARE: MRS. LISA MARIE CRESSON M.F.T., A.T.R

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
1	106H00000X	Marriage & Family Therapist	MFC 48256	CA

General Provider Information

NPI Number	:	1811018310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE CRESSON M.F.T., A.T.R

Provider Business Mailing Address
First Line	:	2116 CIPRIANI BLVD
Second Line	:
City	:	BELMONT
State	:	CA
Zip	:	94002-1534
Country	:	US
Telephone Number	:	415-244-9252
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 MAIN ST
Second Line	:	SUITE 29
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1784
Country	:	US
Telephone Number	:	415-244-9252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	04/06/2010

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