Provider Demographics
NPI:1477191393
Name:GERMEROTH, LISA JENNIFER (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JENNIFER
Last Name:GERMEROTH
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 1:1648 OAKMONTE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-7222
Mailing Address - Country:US
Mailing Address - Phone:585-355-6908
Mailing Address - Fax:
Practice Address - Street 1:4401 FAIRFAX DR STE 205
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1622
Practice Address - Country:US
Practice Address - Phone:571-328-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018790103TC0700X
VA0810007494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical