Provider Demographics
NPI:1952888158
Name:SHAPIRO, LISA A (LISAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3820
Mailing Address - Country:US
Mailing Address - Phone:866-207-3882
Mailing Address - Fax:480-498-3612
Practice Address - Street 1:12409 W INDIAN SCHOOL RD BLDG E
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9502
Practice Address - Country:US
Practice Address - Phone:866-207-3882
Practice Address - Fax:480-498-3612
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10957101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional