Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | #2272 | CA |
NPI | 1013156322 |
---|---|
Provider Name | Mrs. Lisa Marie Maheras |
First Address | San Mateo, CA 94402 |
Second Address | San Mateo, CA 94402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2009 |
Last Update Date | 10/02/2009 |