Provider Demographics
NPI:1518237866
Name:FEIL, LISA VAUGHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:VAUGHN
Last Name:FEIL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAIN ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1518
Mailing Address - Country:US
Mailing Address - Phone:570-723-1005
Mailing Address - Fax:570-723-1006
Practice Address - Street 1:107 MAIN ST UNIT 3
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1518
Practice Address - Country:US
Practice Address - Phone:570-723-1005
Practice Address - Fax:570-723-1006
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist