Provider Demographics
NPI:1194198523
Name:ZACHARIAH, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:ZACHARIAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 ORCHARD HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4137
Mailing Address - Country:US
Mailing Address - Phone:937-441-1828
Mailing Address - Fax:
Practice Address - Street 1:2639 ORCHARD HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4137
Practice Address - Country:US
Practice Address - Phone:937-441-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist