Provider Demographics
NPI:1215602636
Name:LISPI-MURRAY, GINA ELIZABETH (MA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ELIZABETH
Last Name:LISPI-MURRAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4003
Mailing Address - Country:US
Mailing Address - Phone:570-829-1103
Mailing Address - Fax:
Practice Address - Street 1:1169 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4003
Practice Address - Country:US
Practice Address - Phone:570-239-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001120103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty