Provider Demographics
NPI:1194385328
Name:LUSARETA, CHRISTINE ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:LUSARETA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:LUSARETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5329
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94083-5329
Mailing Address - Country:US
Mailing Address - Phone:415-494-9879
Mailing Address - Fax:
Practice Address - Street 1:349 PHILIP DR APT 208
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2425
Practice Address - Country:US
Practice Address - Phone:415-652-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist