Provider Demographics
NPI:1033435144
Name:KRESS-SCUDIERE, LISA RENAE (PCC-S, MED)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENAE
Last Name:KRESS-SCUDIERE
Suffix:
Gender:F
Credentials:PCC-S, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-4270
Mailing Address - Fax:330-543-4271
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-4270
Practice Address - Fax:330-543-4271
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002786101YP2500X
OHE.1200003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional