Provider Demographics
NPI:1710605126
Name:WILKINS-BLOUNT, LISA N (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:N
Last Name:WILKINS-BLOUNT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2601
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-5601
Mailing Address - Country:US
Mailing Address - Phone:609-575-5921
Mailing Address - Fax:
Practice Address - Street 1:1052 CAMELOT CT
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-1569
Practice Address - Country:US
Practice Address - Phone:302-597-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00528600101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health