Provider Demographics
NPI:1679987317
Name:CERRINA, LISA (MA, LMFT, ATR)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CERRINA
Suffix:
Gender:F
Credentials:MA, LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4536 RINETTI LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3311
Mailing Address - Country:US
Mailing Address - Phone:818-653-3312
Mailing Address - Fax:
Practice Address - Street 1:4536 RINETTI LN
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3311
Practice Address - Country:US
Practice Address - Phone:818-653-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC83942106H00000X
CAATCB #13-248221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist