Provider Demographics
NPI:1720534035
Name:ELLIOTT ST.CLAIR, LISSA
Entity Type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name:ELLIOTT ST.CLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BUCKWALTER RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-9313
Mailing Address - Country:US
Mailing Address - Phone:484-587-9922
Mailing Address - Fax:
Practice Address - Street 1:12 BUCKWALTER RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-9313
Practice Address - Country:US
Practice Address - Phone:484-587-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health