Provider Demographics
NPI:1457686453
Name:LISA FARALDO PHD PA
Entity Type:Organization
Organization Name:LISA FARALDO PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARALDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-784-8866
Mailing Address - Street 1:480 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7104
Mailing Address - Country:US
Mailing Address - Phone:954-784-8866
Mailing Address - Fax:
Practice Address - Street 1:480 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7104
Practice Address - Country:US
Practice Address - Phone:954-784-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty