Provider Demographics
NPI:1396574554
Name:CAPPELLETTI, LISA NIGRO (PSYD, PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:NIGRO
Last Name:CAPPELLETTI
Suffix:
Gender:F
Credentials:PSYD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 LEMONA AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2427
Mailing Address - Country:US
Mailing Address - Phone:310-867-4454
Mailing Address - Fax:
Practice Address - Street 1:13749 RIVERSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2446
Practice Address - Country:US
Practice Address - Phone:310-867-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15722103TP0814X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis