Provider Demographics
NPI:1972176816
Name:LATTARULO, LISA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LATTARULO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:STIRLING
Mailing Address - State:NJ
Mailing Address - Zip Code:07980-1112
Mailing Address - Country:US
Mailing Address - Phone:908-809-8725
Mailing Address - Fax:
Practice Address - Street 1:667 SHUNPIKE RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1574
Practice Address - Country:US
Practice Address - Phone:908-809-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00762700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health