Provider Demographics
NPI:1235324443
Name:PARISE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PARISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12910 GROVE HILL RD APT 101
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5580
Mailing Address - Country:US
Mailing Address - Phone:804-482-0477
Mailing Address - Fax:
Practice Address - Street 1:10611 PATTERSON AVE STE 301
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-4733
Practice Address - Country:US
Practice Address - Phone:804-203-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040151761041C0700X
MA1175631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical