Provider Demographics
NPI:1255544706
Name:WIENS, LISA E (PSYD,LP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:WIENS
Suffix:
Gender:F
Credentials:PSYD,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 PERRYSVILLE AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15214-2212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3505 PERRYSVILLE AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15214-2212
Practice Address - Country:US
Practice Address - Phone:724-773-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4182103TC0700X
PAPS016409103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN55B83WIOtherBCBS OF MINNESOTA
MN1022415OtherPREFERRED ONE
MN61 33656OtherUNITED BEHAVIORAL SYSTEMS
MN263519400Medicaid
MN55B83WIOtherBCBS OF MINNESOTA