Provider Demographics
NPI:1548913858
Name:CEFALU, LISA C (CHT, SE)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:CEFALU
Suffix:
Gender:F
Credentials:CHT, SE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4346 MATILIJA AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3682
Mailing Address - Country:US
Mailing Address - Phone:818-219-6642
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:#208-A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90025-9002
Practice Address - Country:US
Practice Address - Phone:818-219-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty