Provider Demographics
NPI:1760030860
Name:CRANDELL, LISA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:E
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 YORKLYN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8748
Mailing Address - Country:US
Mailing Address - Phone:302-239-5255
Mailing Address - Fax:
Practice Address - Street 1:710 YORKLYN RD STE 100
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8748
Practice Address - Country:US
Practice Address - Phone:302-239-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-01
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB2-0000392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty