Provider Demographics
NPI:1679640643
Name:DIMARINO, LISA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:DIMARINO
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 1:4030 HAMILTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1222
Mailing Address - Country:US
Mailing Address - Phone:408-247-8128
Mailing Address - Fax:
Practice Address - Street 1:3860 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4716
Practice Address - Country:US
Practice Address - Phone:650-494-1200
Practice Address - Fax:650-494-1243
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist