Provider Demographics
NPI:1114254950
Name:VERBOS, LISA MARIE (LPC, BCBA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:VERBOS
Suffix:
Gender:F
Credentials:LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FARM HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-8349
Mailing Address - Country:US
Mailing Address - Phone:717-350-1482
Mailing Address - Fax:
Practice Address - Street 1:4400 LINGLESTOWN RD STE 208
Practice Address - Street 2:
Practice Address - City:LINGLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17112-8562
Practice Address - Country:US
Practice Address - Phone:717-350-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-08-4842103K00000X
PAPC007524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst