Provider Demographics
NPI:1528377264
Name:LISA F MARROCCA PC
Entity Type:Organization
Organization Name:LISA F MARROCCA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:MARROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-519-1200
Mailing Address - Street 1:200 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1208
Mailing Address - Country:US
Mailing Address - Phone:248-519-1200
Mailing Address - Fax:248-519-1201
Practice Address - Street 1:200 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1208
Practice Address - Country:US
Practice Address - Phone:248-519-1200
Practice Address - Fax:248-519-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006708103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI266353000OtherMAGELLAN
MI68-0F3-3015-0OtherBCBSM
MI211541OtherVALUE OPTIONS
MIOM22900Medicare UPIN