Provider Demographics
NPI:1124326954
Name:RESNICK, LISA (MA, EDM, LMHC, LPC)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:RESNICK
Suffix:
Gender:F
Credentials:MA, EDM, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 S WARNOCK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3636
Mailing Address - Country:US
Mailing Address - Phone:914-325-1957
Mailing Address - Fax:
Practice Address - Street 1:1315 WINDRIM AVE
Practice Address - Street 2:AOP-6C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2710
Practice Address - Country:US
Practice Address - Phone:215-456-2603
Practice Address - Fax:215-456-2729
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004508-1101YM0800X
PAPC007335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health