Provider Demographics
NPI:1275915761
Name:FOPPA, LISA (MS, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FOPPA
Suffix:
Gender:F
Credentials:MS, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 N OCEAN BLVD UNIT 17
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5311
Mailing Address - Country:US
Mailing Address - Phone:770-573-4803
Mailing Address - Fax:
Practice Address - Street 1:AM DEUTSCHHERRENBERG
Practice Address - Street 2:1G
Practice Address - City:WETZLAR
Practice Address - State:HESSEN
Practice Address - Zip Code:35578
Practice Address - Country:DE
Practice Address - Phone:770-573-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0064101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical