Provider Demographics
NPI:1407929672
Name:STRONG, LISA CARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CARD
Last Name:STRONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 CAMINO DEL RIO S STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3609
Mailing Address - Country:US
Mailing Address - Phone:619-275-2286
Mailing Address - Fax:619-955-5696
Practice Address - Street 1:2221 CAMINO DEL RIO S STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3609
Practice Address - Country:US
Practice Address - Phone:619-275-2286
Practice Address - Fax:619-955-5696
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00759103TC0700X
CAPSY25312103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI689004296Medicare ID - Type Unspecified