Provider Demographics
NPI:1316601610
Name:GEORGE, LISSY
Entity Type:Individual
Prefix:
First Name:LISSY
Middle Name:
Last Name:GEORGE
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 1:9/3 KNOX STREET
Mailing Address - Street 2:
Mailing Address - City:HAMILTON CENTRAL
Mailing Address - State:AA
Mailing Address - Zip Code:3204
Mailing Address - Country:NZ
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9/3 KNOX STREET
Practice Address - Street 2:
Practice Address - City:HAMILTON CENTRAL
Practice Address - State:WAIKATO
Practice Address - Zip Code:3204
Practice Address - Country:NZ
Practice Address - Phone:022-646-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty