Provider Demographics
NPI:1992325336
Name:SONDIN, LISA (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SONDIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PORTO BELLO DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4225
Mailing Address - Country:US
Mailing Address - Phone:415-706-9087
Mailing Address - Fax:
Practice Address - Street 1:21 TAMAL VISTA BLVD STE 216
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1127
Practice Address - Country:US
Practice Address - Phone:415-706-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist