Provider Demographics
NPI:1427376847
Name:TALBOT, LISA A (PSYD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:TALBOT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1020
Mailing Address - Country:US
Mailing Address - Phone:610-924-0971
Mailing Address - Fax:610-664-7682
Practice Address - Street 1:525 PLYMOUTH RD
Practice Address - Street 2:SUITE 308
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1640
Practice Address - Country:US
Practice Address - Phone:610-825-9400
Practice Address - Fax:610-825-7130
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS00888IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist