Provider Demographics
NPI:1861258584
Name:MANN-CERVERA, LISSA MICHELLE (MA)
Entity type:Individual
Prefix:MRS
First Name:LISSA
Middle Name:MICHELLE
Last Name:MANN-CERVERA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83722 ANDES CT
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-4035
Mailing Address - Country:US
Mailing Address - Phone:857-719-9421
Mailing Address - Fax:
Practice Address - Street 1:30310 LANDAU BLVD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5200
Practice Address - Country:US
Practice Address - Phone:760-770-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200062042103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool