Provider Demographics
NPI:1588873699
Name:PARADIS, LISA JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:JANE
Last Name:PARADIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 ROCK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1707
Mailing Address - Country:US
Mailing Address - Phone:201-493-0560
Mailing Address - Fax:201-493-0560
Practice Address - Street 1:206 ROCK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1707
Practice Address - Country:US
Practice Address - Phone:201-493-0560
Practice Address - Fax:201-493-0560
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI3880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist