Provider Demographics
NPI:1710097662
Name:DEGUIRE, LISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISE
Middle Name:
Last Name:DEGUIRE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 STRAUBE CENTER BLVD
Mailing Address - Street 2:BUILDING K; SUITE 1-7
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1450
Mailing Address - Country:US
Mailing Address - Phone:609-737-7795
Mailing Address - Fax:
Practice Address - Street 1:114 STRAUBE CENTER BLVD
Practice Address - Street 2:BUILDING K; SUITE 1-7
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1450
Practice Address - Country:US
Practice Address - Phone:609-737-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100298400103TC0700X
PAPS006103L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048988Medicare ID - Type Unspecified