Provider Demographics
NPI:1518103738
Name:WEISSBACH-EFRAT, LISA (LSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WEISSBACH-EFRAT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SPRINGDALE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2763
Mailing Address - Country:US
Mailing Address - Phone:856-424-1333
Mailing Address - Fax:856-424-7384
Practice Address - Street 1:702 BIRCHFIELD DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4013
Practice Address - Country:US
Practice Address - Phone:856-778-7775
Practice Address - Fax:856-778-7710
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSL053485104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker