Provider Demographics
NPI:1033578836
Name:GAGNON, LYSSA (PHD)
Entity Type:Individual
Prefix:
First Name:LYSSA
Middle Name:
Last Name:GAGNON
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:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-1830
Mailing Address - Country:US
Mailing Address - Phone:484-862-3193
Mailing Address - Fax:484-664-7659
Practice Address - Street 1:1250 S CEDAR CREST BLVD STE 410
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6224
Practice Address - Country:US
Practice Address - Phone:610-402-3500
Practice Address - Fax:610-402-3505
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018013103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical