Provider Demographics
NPI:1508037433
Name:MACIOCI, LISA MARIA LEE (MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA LEE
Last Name:MACIOCI
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 1:395 TAYLOR BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2298
Mailing Address - Country:US
Mailing Address - Phone:925-448-0866
Mailing Address - Fax:
Practice Address - Street 1:395 TAYLOR BLVD STE 115
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2298
Practice Address - Country:US
Practice Address - Phone:925-448-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106H00000X
CA51566106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor