Provider Demographics
NPI:1427350958
Name:LIS, LINDA MAY (LPC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MAY
Last Name:LIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HAWTHORNE PL
Mailing Address - Street 2:2F
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3229
Mailing Address - Country:US
Mailing Address - Phone:201-248-7869
Mailing Address - Fax:973-707-5749
Practice Address - Street 1:36 HAWTHORNE PL
Practice Address - Street 2:2F
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3229
Practice Address - Country:US
Practice Address - Phone:201-248-7869
Practice Address - Fax:973-707-5749
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00004800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional