Provider Demographics
NPI:1063670586
Name:VESCERA, LIZZETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:VESCERA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4761 LAGUNITA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-1214
Mailing Address - Country:US
Mailing Address - Phone:562-257-6528
Mailing Address - Fax:866-506-5725
Practice Address - Street 1:2659 STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1627
Practice Address - Country:US
Practice Address - Phone:562-257-6528
Practice Address - Fax:866-506-5725
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist