Provider Demographics
NPI:1558762799
Name:FALLARA, LISA (LISW-S)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FALLARA
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3763 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4056
Mailing Address - Country:US
Mailing Address - Phone:614-257-8442
Mailing Address - Fax:
Practice Address - Street 1:3763 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3547
Practice Address - Country:US
Practice Address - Phone:614-257-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.08001611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.0800161OtherOHIO SOCIAL WORK AND COUNSELOR BOARD