Provider Demographics
NPI:1902953037
Name:MIRABELLI, LISA ALEXANDRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ALEXANDRA
Last Name:MIRABELLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5739 MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3427
Mailing Address - Country:US
Mailing Address - Phone:323-839-8526
Mailing Address - Fax:626-798-0338
Practice Address - Street 1:101 S MADISON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2545
Practice Address - Country:US
Practice Address - Phone:323-839-8526
Practice Address - Fax:626-798-0338
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19144103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical