Provider Demographics
NPI:1891824306
Name:SWOROWSKI, LISA ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:SWOROWSKI
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 1:10700 SIKES PL STE 380
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8175
Mailing Address - Country:US
Mailing Address - Phone:704-246-7758
Mailing Address - Fax:980-262-3036
Practice Address - Street 1:10700 SIKES PL STE 380
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8175
Practice Address - Country:US
Practice Address - Phone:704-246-7758
Practice Address - Fax:980-262-3036
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041849A103G00000X, 103T00000X, 103TC0700X, 103TA0700X
IL071006373103G00000X, 103T00000X, 103TA0700X, 103TC0700X
NC4230103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635182OtherBLUECROSS BLUESHIELD PPO