Provider Demographics
NPI:1104044825
Name:LERA, DONNA-MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:DONNA-MARIE
Middle Name:
Last Name:LERA
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 1:790 LAUREL ST STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3165
Mailing Address - Country:US
Mailing Address - Phone:650-576-8640
Mailing Address - Fax:650-508-8549
Practice Address - Street 1:790 LAUREL ST STE 114
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3165
Practice Address - Country:US
Practice Address - Phone:650-576-8640
Practice Address - Fax:650-508-8549
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT41541101YM0800X
CAMFC 41541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health