Provider Demographics
NPI:1477683423
Name:SISTI, NANCY D (LMFT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:D
Last Name:SISTI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 20TH ST
Mailing Address - Street 2:APARTMENT E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2759
Mailing Address - Country:US
Mailing Address - Phone:310-392-7554
Mailing Address - Fax:310-392-5679
Practice Address - Street 1:530 WILSHIRE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1421
Practice Address - Country:US
Practice Address - Phone:310-392-7554
Practice Address - Fax:310-392-5679
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11643094OtherCAQH UNIVERSAL CREDENTIAL