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NPI Code Detail

MEDICARE: MRS. LISA M CLEMENTE MFT

MEDICARE: MRS. LISA M CLEMENTE MFT
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
1106H00000XMarriage & Family TherapistMFC46073CA
2106H00000XMarriage & Family TherapistLMFT46073CA

General Provider Information

NPI Number : 1922139088
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA M CLEMENTE MFT
Provider Business Mailing Address
First Line : 6305 WOODMAN AVE
Second Line :
City : VAN NUYS
State : CA
Zip : 91401-2346
Country : US
Telephone Number : 818-908-4999
Fax Number : 818-780-0153
Provider Business Practice Location Address
First Line : 6305 WOODMAN AVE
Second Line :
City : VAN NUYS
State : CA
Zip : 91401-2346
Country : US
Telephone Number : 818-908-4999
Fax Number : 818-780-0153
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 02/06/2017

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Directions to “ MRS. LISA M CLEMENTE MFT” Practice Location

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