Provider Demographics
NPI:1356091375
Name:MALAGISE, LISA JEAN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:MALAGISE
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 1:147 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2819
Mailing Address - Country:US
Mailing Address - Phone:412-853-5472
Mailing Address - Fax:
Practice Address - Street 1:150 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-1360
Practice Address - Country:US
Practice Address - Phone:724-888-2097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000945103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst