Provider Demographics
NPI:1144608027
Name:TIMBERLAKE, LISA HATCH (LSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:HATCH
Last Name:TIMBERLAKE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4210
Mailing Address - Country:US
Mailing Address - Phone:717-843-5011
Mailing Address - Fax:
Practice Address - Street 1:2000 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4210
Practice Address - Country:US
Practice Address - Phone:717-843-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA131877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker