Provider Demographics
NPI:1285833111
Name:GIOVANNETTI, LISA (LPCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GIOVANNETTI
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-3503
Mailing Address - Fax:415-639-1382
Practice Address - Street 1:484 E SAN FERNANDO ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3513
Practice Address - Country:US
Practice Address - Phone:408-293-0422
Practice Address - Fax:408-277-2474
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07-039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALPCC636OtherLICENSED PROFESSIONAL CLINICAL COUNCELOR
CA109525OtherSAN JOSE CITY ID