Provider Demographics
NPI:1427501105
Name:PAULA DEFRISCO, LCSW
Entity type:Organization
Organization Name:PAULA DEFRISCO, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRISCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-235-2800
Mailing Address - Street 1:570 FUNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5683
Mailing Address - Country:US
Mailing Address - Phone:805-235-2800
Mailing Address - Fax:805-439-2487
Practice Address - Street 1:11549 LOS OSOS VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-6471
Practice Address - Country:US
Practice Address - Phone:805-235-2800
Practice Address - Fax:805-439-2487
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAULA DEFRISCO, LCSW, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS27899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty