Provider Demographics
NPI:1891805529
Name:FENDER-SCARR, LISA KAY
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:FENDER-SCARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 ROCKSIDE RD
Mailing Address - Street 2:#207 ROCKSIDE SQUARE 2
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131
Mailing Address - Country:US
Mailing Address - Phone:216-520-5969
Mailing Address - Fax:216-520-5098
Practice Address - Street 1:6133 ROCKSIDE RD
Practice Address - Street 2:#207 ROCKSIDE SQUARE 2
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131
Practice Address - Country:US
Practice Address - Phone:216-520-5969
Practice Address - Fax:216-520-5098
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN