Provider Demographics
NPI:1689308405
Name:SPECTOR, LISA (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SPECTOR
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 1:5121 CLARIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9478
Mailing Address - Country:US
Mailing Address - Phone:614-208-4862
Mailing Address - Fax:
Practice Address - Street 1:5121 CLARIDGE DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9478
Practice Address - Country:US
Practice Address - Phone:614-208-4862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007343-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health