Provider Demographics
NPI:1881311439
Name:LISBON, CHRISTY (LSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:LISBON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SOLOMON TEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-3739
Mailing Address - Country:US
Mailing Address - Phone:724-433-9841
Mailing Address - Fax:
Practice Address - Street 1:1 NORTHGATE SQ STE 218
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1374
Practice Address - Country:US
Practice Address - Phone:724-689-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139614104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker