Provider Demographics
NPI:1336186576
Name:CAVALLARO, LISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23560 MADISON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4708
Mailing Address - Country:US
Mailing Address - Phone:310-540-5514
Mailing Address - Fax:310-325-9201
Practice Address - Street 1:23560 MADISON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4708
Practice Address - Country:US
Practice Address - Phone:310-540-5514
Practice Address - Fax:310-325-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical