Provider Demographics
NPI:1093372401
Name:HARABURDA, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HARABURDA
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 1:307 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-3708
Mailing Address - Country:US
Mailing Address - Phone:215-858-7717
Mailing Address - Fax:
Practice Address - Street 1:4 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1314
Practice Address - Country:US
Practice Address - Phone:215-757-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health