Provider Demographics
NPI:1063860260
Name:LYSIAK, LAUREN ELIZABETH (CHES)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:LYSIAK
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9469 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-6506
Mailing Address - Country:US
Mailing Address - Phone:518-774-1215
Mailing Address - Fax:
Practice Address - Street 1:9469 ERIE RD
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-6506
Practice Address - Country:US
Practice Address - Phone:518-774-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator