Provider Demographics
NPI:1710128574
Name:MERCONCHINI, LISA ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:MERCONCHINI
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 1:110 E BROWARD BLVD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3503
Mailing Address - Country:US
Mailing Address - Phone:954-415-5343
Mailing Address - Fax:954-315-0263
Practice Address - Street 1:110 E BROWARD BLVD
Practice Address - Street 2:SUITE 1700
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3503
Practice Address - Country:US
Practice Address - Phone:954-415-5343
Practice Address - Fax:954-315-0263
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical