Provider Demographics
NPI:1306386800
Name:GAMBINA, KARISSA ROSSI (LMFT 117142)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:ROSSI
Last Name:GAMBINA
Suffix:
Gender:F
Credentials:LMFT 117142
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16580 HARBOR BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1385
Mailing Address - Country:US
Mailing Address - Phone:949-632-9996
Mailing Address - Fax:
Practice Address - Street 1:16580 HARBOR BLVD STE M
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1385
Practice Address - Country:US
Practice Address - Phone:949-632-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117142106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist