Individual
DR. LISA LAVAYSSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
205 E 3RD AVE, MEZZANINE 1-A, SAN MATEO, CA 94401-4051
(650) 576-3017
Mailing address
205 E 3RD AVE, MEZZANINE 1-A, SAN MATEO, CA 94401-4051
(650) 576-3017
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY20002
CA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY20002
CA
Other
Enumeration date
05/19/2010
Last updated
05/19/2010
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