Provider Demographics
NPI:1154347623
Name:ROONEY, LISA K (PHD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:ROONEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1519
Mailing Address - Country:US
Mailing Address - Phone:610-812-6163
Mailing Address - Fax:
Practice Address - Street 1:191 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1215
Practice Address - Country:US
Practice Address - Phone:610-812-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005188L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0483287000OtherPERSONAL CHOICE
PA568609000OtherMIS
PARO651955OtherBLUE SHIELD
PA3282980OtherAETNA
PARO651955OtherBLUE SHIELD