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NPI Code Detail

MEDICARE: MS. LISA DANYLCHUK ED.M., C.A.S., MFTI

MEDICARE: MS. LISA DANYLCHUK ED.M., C.A.S., MFTI
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 CounselorMA
2106H00000XMarriage & Family TherapistIMF 55788CA

General Provider Information

NPI Number : 1891963906
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA DANYLCHUK ED.M., C.A.S., MFTI
Provider Business Mailing Address
First Line : 2275 ARLINGTON DR
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94578-1132
Country : US
Telephone Number : 510-481-1222
Fax Number :
Provider Business Practice Location Address
First Line : 2513 24TH ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94110-3556
Country : US
Telephone Number : 415-642-5968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2008
Last Update Date : 02/12/2008

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