Individual
LISA RUSSO PETTIGREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RSMT, PHD. CANDIDATE
Contact information
Practice address
340 S STATE HIGHWAY 138, CRESTLINE, CA 92325-9153
(909) 336-3330
Mailing address
PO BOX 6300, CRESTLINE, CA 92325-6300
(909) 336-3330
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
09/14/2023
Last updated
02/06/2025
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