Provider Demographics
NPI:1780841908
Name:LISA SAPONARO PHD INC
Entity Type:Organization
Organization Name:LISA SAPONARO PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPONARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-560-9567
Mailing Address - Street 1:1469 NW 129TH WAY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2984
Mailing Address - Country:US
Mailing Address - Phone:954-560-9567
Mailing Address - Fax:
Practice Address - Street 1:2 S UNIVERSITY DR
Practice Address - Street 2:SUITE 304
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3355
Practice Address - Country:US
Practice Address - Phone:954-560-9567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7494103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty