Provider Demographics
NPI:1063603561
Name:DABERKOW STALP, LISA J (PHD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:DABERKOW STALP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:DABERKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3011 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3403
Mailing Address - Country:US
Mailing Address - Phone:816-751-7900
Mailing Address - Fax:816-751-7981
Practice Address - Street 1:3011 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-3403
Practice Address - Country:US
Practice Address - Phone:816-751-7732
Practice Address - Fax:816-751-7981
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01859103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist