Provider Demographics
NPI:1073841912
Name:LAITMAN, LISA A (MSED)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:LAITMAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SENIOR ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-8534
Mailing Address - Country:US
Mailing Address - Phone:732-932-7884
Mailing Address - Fax:732-932-8278
Practice Address - Street 1:17 SENIOR ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-8534
Practice Address - Country:US
Practice Address - Phone:732-932-7884
Practice Address - Fax:732-932-8278
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00035400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)