Provider Demographics
NPI:1962836312
Name:MUSARRA, LISA S (LSW, LCADC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:MUSARRA
Suffix:
Gender:F
Credentials:LSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 193
Mailing Address - Street 2:
Mailing Address - City:SHIP BOTTOM
Mailing Address - State:NJ
Mailing Address - Zip Code:08008
Mailing Address - Country:US
Mailing Address - Phone:609-384-6609
Mailing Address - Fax:610-981-6078
Practice Address - Street 1:118 N. BAY AVENUE, UNIT #1
Practice Address - Street 2:
Practice Address - City:BEACH HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:08008
Practice Address - Country:US
Practice Address - Phone:609-384-6609
Practice Address - Fax:610-981-6078
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NJ37LC00237100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor