Provider Demographics
NPI:1437825882
Name:FORD, LISA AMY (MS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:AMY
Last Name:FORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:AMY
Other - Last Name:WIECHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1314
Mailing Address - Country:US
Mailing Address - Phone:215-757-6916
Mailing Address - Fax:
Practice Address - Street 1:4 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1314
Practice Address - Country:US
Practice Address - Phone:215-757-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health