Provider Demographics
NPI:1720534035
Name:ELLIOTT ST.CLAIR, LISSA
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name:ELLIOTT ST.CLAIR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 OLD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-8918
Mailing Address - Country:US
Mailing Address - Phone:484-587-9922
Mailing Address - Fax:
Practice Address - Street 1:1344 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-8918
Practice Address - Country:US
Practice Address - Phone:484-587-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012907101YP2500X
101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health