Provider Demographics
NPI:1205012713
Name:BISHOP, LISA MARY (MS, RD, CDE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARY
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-371-7048
Mailing Address - Fax:203-371-7066
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-371-7048
Practice Address - Fax:203-371-7066
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000725133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered