Provider Demographics
NPI:1821307679
Name:BIRCHFIELD, LISA MARIE (BA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BIRCHFIELD
Suffix:
Gender:F
Credentials:BA
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 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-821-8038
Mailing Address - Fax:
Practice Address - Street 1:13101 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3803
Practice Address - Country:US
Practice Address - Phone:813-821-8038
Practice Address - Fax:813-974-4325
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2024-02-06
Deactivation Date:2011-02-22
Deactivation Code:
Reactivation Date:2022-09-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119910100Medicaid