Provider Demographics
NPI:1194186411
Name:VINNACOMBE, LISA (MSS, MLSP, LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:VINNACOMBE
Suffix:
Gender:F
Credentials:MSS, MLSP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 ARCH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1479
Mailing Address - Country:US
Mailing Address - Phone:484-367-5808
Mailing Address - Fax:
Practice Address - Street 1:2133 ARCH ST STE 302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1479
Practice Address - Country:US
Practice Address - Phone:484-367-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128855104100000X
PACW0195911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker