Provider Demographics
NPI:1437341997
Name:RAPALLO, LISA DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:RAPALLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W BENSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3829
Mailing Address - Country:US
Mailing Address - Phone:907-231-0536
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD, BLDG 217
Practice Address - Street 2:VETERAN'S ADMINISTRATION HOSPITAL (DOMICILIARY)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2026881041C0700X
CA282231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical