Provider Demographics
NPI:1033439021
Name:CARR, LISA M (MA,BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:CARR
Suffix:
Gender:F
Credentials:MA,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SEVEN OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1313
Mailing Address - Country:US
Mailing Address - Phone:973-377-3790
Mailing Address - Fax:973-377-3790
Practice Address - Street 1:17 SEVEN OAKS CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1313
Practice Address - Country:US
Practice Address - Phone:973-377-3790
Practice Address - Fax:973-377-3790
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-09-6524103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst