Provider Demographics
NPI:1063836047
Name:CIRACO, LISA MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIA
Last Name:CIRACO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CEDAR TERRACE
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859
Mailing Address - Country:US
Mailing Address - Phone:732-501-1339
Mailing Address - Fax:
Practice Address - Street 1:73 CEDAR TERRACE
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859
Practice Address - Country:US
Practice Address - Phone:732-501-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5115103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool