Provider Demographics
NPI:1073784294
Name:SIVIERI, LISA KATHLEEN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KATHLEEN
Last Name:SIVIERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:SIVIERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:66 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1813
Mailing Address - Country:US
Mailing Address - Phone:856-589-2948
Mailing Address - Fax:
Practice Address - Street 1:9101 CHERRY LN
Practice Address - Street 2:SUITE 205
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1133
Practice Address - Country:US
Practice Address - Phone:301-490-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-15
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01633171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist