Provider Demographics
NPI:1437335486
Name:GERWIG, LISA A (MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:GERWIG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-7902
Mailing Address - Country:US
Mailing Address - Phone:760-715-0920
Mailing Address - Fax:
Practice Address - Street 1:2777 JEFFERSON ST
Practice Address - Street 2:STE 201
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1743
Practice Address - Country:US
Practice Address - Phone:760-715-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist