Basic Information
| Provider Information | |||||||||
| NPI: | 1285833111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIOVANNETTI | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156003503 | ||||||||
| FaxNumber: | 4156391382 | ||||||||
| Practice Location | |||||||||
| Address1: | 484 E SAN FERNANDO ST | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951123513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082930422 | ||||||||
| FaxNumber: | 4082772474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 07-039 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | LPCC636 | 01 | CA | LICENSED PROFESSIONAL CLINICAL COUNCELOR | OTHER | 109525 | 01 | CA | SAN JOSE CITY ID | OTHER |