Provider Demographics
NPI:1437375342
Name:GERARD, LISA RENE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENE
Last Name:GERARD
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14600 SHERMAN WAY
Mailing Address - Street 2:SUTITE 100 D
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2283
Mailing Address - Country:US
Mailing Address - Phone:818-374-6901
Mailing Address - Fax:818-909-9980
Practice Address - Street 1:14600 SHERMAN WAY
Practice Address - Street 2:SUITE 100D
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2283
Practice Address - Country:US
Practice Address - Phone:818-374-6901
Practice Address - Fax:818-909-9980
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist