Provider Demographics
NPI:1275066466
Name:LAGALA, LISA MARIE (NCC, LPC, ACS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:LAGALA
Suffix:
Gender:F
Credentials:NCC, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BAYARD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2389
Mailing Address - Country:US
Mailing Address - Phone:732-847-2869
Mailing Address - Fax:732-851-1031
Practice Address - Street 1:1049 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1334
Practice Address - Country:US
Practice Address - Phone:732-852-7750
Practice Address - Fax:732-454-5325
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00595400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional