Provider Demographics
NPI:1316221849
Name:ECKLEY-DLUTOWSKI, LISA DANELLE (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DANELLE
Last Name:ECKLEY-DLUTOWSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 SUMMER COVE DR E
Mailing Address - Street 2:APT. # 133
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-4975
Mailing Address - Country:US
Mailing Address - Phone:941-914-6532
Mailing Address - Fax:941-721-8950
Practice Address - Street 1:4514 SUMMER COVE DR E
Practice Address - Street 2:APT. # 133
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-4975
Practice Address - Country:US
Practice Address - Phone:941-914-6532
Practice Address - Fax:941-721-8950
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health