Provider Demographics
NPI:1821602087
Name:FAUL, LISA ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNETTE
Last Name:FAUL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-1935
Mailing Address - Country:US
Mailing Address - Phone:601-260-5325
Mailing Address - Fax:
Practice Address - Street 1:1432 EASTON RD
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2852
Practice Address - Country:US
Practice Address - Phone:601-260-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0209331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical