Provider Demographics
NPI:1942609391
Name:WUCINICH, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WUCINICH
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 1:937 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3330
Mailing Address - Country:US
Mailing Address - Phone:614-797-5900
Mailing Address - Fax:
Practice Address - Street 1:937 EASTWIND DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3330
Practice Address - Country:US
Practice Address - Phone:614-797-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool