Provider Demographics
NPI:1184266983
Name:LISA, CHRISTINE (PMHNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LISA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2212
Mailing Address - Country:US
Mailing Address - Phone:201-880-7440
Mailing Address - Fax:201-987-7558
Practice Address - Street 1:297 HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2212
Practice Address - Country:US
Practice Address - Phone:201-880-7440
Practice Address - Fax:201-987-7558
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00972100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health