Provider Demographics
NPI:1285180042
Name:KOSIK, LISA L
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:KOSIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CHERYL
Other - Last Name:LOUGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1602 APPLETREE RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3106
Mailing Address - Country:US
Mailing Address - Phone:717-303-9471
Mailing Address - Fax:
Practice Address - Street 1:900 N 6TH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-1703
Practice Address - Country:US
Practice Address - Phone:717-233-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst