Provider Demographics
NPI:1568801686
Name:GUNSBERG, LISA JOANNE (BS AND MAT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JOANNE
Last Name:GUNSBERG
Suffix:
Gender:F
Credentials:BS AND MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 RIDGEFIELD CIRCLE#204
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFILED
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-788-2854
Mailing Address - Fax:
Practice Address - Street 1:6580 RIDGEFIELD CIRCLE#204
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFILED
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-788-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator