Provider Demographics
NPI:1104839653
Name:COSENTINO, LISA GABRIELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:GABRIELLE
Last Name:COSENTINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E SOLA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2211
Mailing Address - Country:US
Mailing Address - Phone:805-564-1999
Mailing Address - Fax:805-568-0693
Practice Address - Street 1:510 E SOLA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2211
Practice Address - Country:US
Practice Address - Phone:805-564-1999
Practice Address - Fax:805-568-0693
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY108640Medicaid
CACP10864Medicare UPIN