Provider Demographics
NPI:1093956419
Name:SCHENITZKI, LISA FARRELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:FARRELL
Last Name:SCHENITZKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N TUSTIN AVE
Mailing Address - Street 2:SUITE 128
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3779
Mailing Address - Country:US
Mailing Address - Phone:714-552-2552
Mailing Address - Fax:
Practice Address - Street 1:505 N TUSTIN AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3779
Practice Address - Country:US
Practice Address - Phone:714-552-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical