Provider Demographics
NPI:1508524042
Name:AVENT, LISA ANN (PCA CHHA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:AVENT
Suffix:
Gender:F
Credentials:PCA CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1311
Mailing Address - Country:US
Mailing Address - Phone:973-870-1973
Mailing Address - Fax:
Practice Address - Street 1:68 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1311
Practice Address - Country:US
Practice Address - Phone:973-870-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN0000529720172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker