Provider Demographics
NPI:1780015834
Name:REIDINGER, LISA (CSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:REIDINGER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BULMER DR
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07439-1005
Mailing Address - Country:US
Mailing Address - Phone:973-827-6684
Mailing Address - Fax:
Practice Address - Street 1:5 BULMER DR
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07439-1005
Practice Address - Country:US
Practice Address - Phone:973-827-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW00940400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1992911325Medicaid