Provider Demographics
NPI:1083940563
Name:RENDALL, LISA TELL
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:TELL
Last Name:RENDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 SAXONBURG BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-3168
Mailing Address - Country:US
Mailing Address - Phone:412-767-5967
Mailing Address - Fax:
Practice Address - Street 1:3394 SAXONBURG BLVD
Practice Address - Street 2:SUITE 620
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-3168
Practice Address - Country:US
Practice Address - Phone:412-767-5967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016623103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist