Provider Demographics
NPI:1689824054
Name:SCHNELLER, LISA M HALLQUIST (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M HALLQUIST
Last Name:SCHNELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M HALLQUIST
Other - Last Name:HALLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2000 OLD WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2712
Mailing Address - Country:US
Mailing Address - Phone:484-454-8700
Mailing Address - Fax:
Practice Address - Street 1:2000 OLD WEST CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2712
Practice Address - Country:US
Practice Address - Phone:484-454-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069403-11041C0700X
PACW0180311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical