Provider Demographics
NPI:1295713345
Name:MONTALVO, LISA A (MFT, CEAP,SAP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:MFT, CEAP,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 SAN CARLOS AVE
Mailing Address - Street 2:SUITE C#4
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2388
Mailing Address - Country:US
Mailing Address - Phone:650-631-0909
Mailing Address - Fax:650-631-0909
Practice Address - Street 1:1395 SAN CARLOS AVE
Practice Address - Street 2:SUITE C#4
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2388
Practice Address - Country:US
Practice Address - Phone:650-631-0909
Practice Address - Fax:650-631-0909
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-07
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 31889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist