Provider Demographics
NPI:1013313386
Name:LEPORE, MARISA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:LEPORE
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 1:23411 SUMMERFIELD #12-G
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4814
Mailing Address - Country:US
Mailing Address - Phone:949-306-3368
Mailing Address - Fax:949-305-4567
Practice Address - Street 1:19742 MACARTHUR BLVD STE 235
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2446
Practice Address - Country:US
Practice Address - Phone:949-306-3368
Practice Address - Fax:949-305-4567
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist