Provider Demographics
NPI:1700985447
Name:LIZZA, MARCIA LAREW (CTRS)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LAREW
Last Name:LIZZA
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:LAREW
Other - Last Name:LIZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:17 FROST CT
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2215
Mailing Address - Country:US
Mailing Address - Phone:415-388-7934
Mailing Address - Fax:
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:NH
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32827225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist