Provider Demographics
NPI:1477714558
Name:HARRISON, LISA FERN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:FERN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 AMETHYST DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8084
Mailing Address - Country:US
Mailing Address - Phone:765-807-5379
Mailing Address - Fax:
Practice Address - Street 1:115 FARABEE DR N
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5913
Practice Address - Country:US
Practice Address - Phone:765-423-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker