Provider Demographics
NPI:1750616678
Name:CONDON, LISA J (MA, PSYD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:CONDON
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MAIN ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2774
Mailing Address - Country:US
Mailing Address - Phone:508-524-0818
Mailing Address - Fax:
Practice Address - Street 1:222 MAIN ST UNIT 203
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2774
Practice Address - Country:US
Practice Address - Phone:508-524-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10777103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical