Provider Demographics
NPI:1902431026
Name:SUMMERS, LISA FERRARA (MFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:FERRARA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 SEABROOK CT
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-8478
Mailing Address - Country:US
Mailing Address - Phone:650-218-6130
Mailing Address - Fax:
Practice Address - Street 1:1139 SAN CARLOS AVE STE 310
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2450
Practice Address - Country:US
Practice Address - Phone:650-521-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health