Provider Demographics
NPI:1861468563
Name:YOUNG, LISA ALTMAN (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ALTMAN
Last Name:YOUNG
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 1:1993 CATO AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2754
Mailing Address - Country:US
Mailing Address - Phone:814-231-8820
Mailing Address - Fax:814-231-8857
Practice Address - Street 1:1993 CATO AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2754
Practice Address - Country:US
Practice Address - Phone:814-231-8820
Practice Address - Fax:814-231-8857
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-008570-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA237841OtherVALUE OTIONS
PA7022442OtherGEISINGER HEALTH PLAN
PA1526455OtherUNITED MINE WORKERS OF AM
PA1042598OtherCIGNA BEHAVIORAL HEALTH
PA1042598OtherCIGNA BEHAVIORAL HEALTH