Provider Demographics
NPI:1043359193
Name:KING, LISA MARIE (PSYD, MSW, LP, CAP)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:PSYD, MSW, LP, CAP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FRIEMARK, NIEMAN, NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5633
Mailing Address - Country:US
Mailing Address - Phone:239-659-2345
Mailing Address - Fax:
Practice Address - Street 1:950 6TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5633
Practice Address - Country:US
Practice Address - Phone:239-659-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801078040101YA0400X, 101YM0800X, 1041C0700X
FLPY9434103TC0700X, 103TA0400X, 103TB0200X
FL010141-2015101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426214Medicare ID - Type Unspecified