Provider Demographics
NPI:1588310973
Name:DILLARD, LISA (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 OLD YORK RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-0361
Mailing Address - Country:US
Mailing Address - Phone:215-376-6200
Mailing Address - Fax:215-376-6191
Practice Address - Street 1:610 OLD YORK RD
Practice Address - Street 2:SUITE 220
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-0361
Practice Address - Country:US
Practice Address - Phone:215-376-6200
Practice Address - Fax:215-376-6191
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACCW0213931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical