Provider Demographics
NPI:1952523003
Name:SHARP, LISA KAY (BSN, MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KAY
Last Name:SHARP
Suffix:
Gender:F
Credentials:BSN, MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 N KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1203
Mailing Address - Country:US
Mailing Address - Phone:312-355-3569
Mailing Address - Fax:
Practice Address - Street 1:MC 275 1747 W ROOSEVELT RD
Practice Address - Street 2:UNIVERSITY OF ILLINOIS AT CHICAGO WESTSIDE RESEARCH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:312-355-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical