Active NPI
Lisa Grace Polisano
- Marriage & Family Therapist
- Camarillo, CA
National Provider Identifier
1043342140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 46922
- Practice address
- 975 Flynn Rd
Camarillo, CA 93012-8704 - Phone
- (805) 914-1439
- Fax
- (805) 482-0987
- NPI assigned
- Mar 12, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 46922 | CA | Primary |
Addresses
Primary practice location
975 Flynn Rd
Camarillo, CA 93012-8704
Mailing address
4798 Sullivan St
#103
Ventura, CA 93003-8213
Phone (818) 929-6586
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46922 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236816000000",
"number": "1043342140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4798 SULLIVAN ST",
"address_2": "#103",
"city": "VENTURA",
"state": "CA",
"postal_code": "930038213",
"telephone_number": "818-929-6586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 FLYNN RD",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930128704",
"telephone_number": "805-914-1439",
"fax_number": "805-482-0987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLISANO",
"first_name": "LISA",
"middle_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-12",
"last_updated": "2009-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "46922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camarillo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.