Provider Demographics
NPI:1215563184
Name:DITTMAN, LISA MARIE (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DITTMAN
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3305
Mailing Address - Country:US
Mailing Address - Phone:732-840-1516
Mailing Address - Fax:732-840-1516
Practice Address - Street 1:3 CREEK RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3305
Practice Address - Country:US
Practice Address - Phone:732-840-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00045500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37PC00045500OtherNON MEDICARE