MEDICARE: MS. LISA DALESANDRO

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	101YM0800X	Mental Health Counselor	147387	CA

General Provider Information

NPI Number	:	1821832031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA DALESANDRO

Provider Business Mailing Address
First Line	:	3521 BERRY DR
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3882
Country	:	US
Telephone Number	:	310-730-1956
Fax Number	:

Provider Business Practice Location Address
First Line	:	3521 BERRY DR
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3882
Country	:	US
Telephone Number	:	310-730-1956
Fax Number	:

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

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/21/2024

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