Provider Demographics
NPI:1245361807
Name:GUNDERSHEIMER, LISA (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:GUNDERSHEIMER
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BARON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW
Mailing Address - Street 1:605 W MAIN ST
Mailing Address - Street 2:STE 206
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1694
Mailing Address - Country:US
Mailing Address - Phone:919-988-0353
Mailing Address - Fax:919-710-8219
Practice Address - Street 1:605 W MAIN ST
Practice Address - Street 2:STE 206
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1694
Practice Address - Country:US
Practice Address - Phone:919-988-0353
Practice Address - Fax:919-710-8219
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0086541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical