Provider Demographics
NPI:1942485370
Name:OLIVETO, LISA A (LMHP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:OLIVETO
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:BRIDGFORD-OLIVETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP
Mailing Address - Street 1:115 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3229
Mailing Address - Country:US
Mailing Address - Phone:402-553-6000
Mailing Address - Fax:402-553-2428
Practice Address - Street 1:115 S 46TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3229
Practice Address - Country:US
Practice Address - Phone:402-553-6000
Practice Address - Fax:402-553-2428
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health