Provider Demographics
NPI:1629588793
Name:STANDFEST, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STANDFEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431A PENN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242-1113
Mailing Address - Country:US
Mailing Address - Phone:814-275-1237
Mailing Address - Fax:
Practice Address - Street 1:431A PENN ST
Practice Address - Street 2:
Practice Address - City:NEW BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:16242-1113
Practice Address - Country:US
Practice Address - Phone:814-275-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PC009891101YP2500X
PAPC009891101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional