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NPI Code Detail

MEDICARE: DR. LISA EILEEN LOVELACE PSY.D.

MEDICARE: DR. LISA EILEEN LOVELACE PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist3561-57WI
2103TC0700XClinical Psychologist017260NY
3103T00000XPsychologistLP5379MN

General Provider Information

NPI Number : 1104090646
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA EILEEN LOVELACE PSY.D.
Provider Business Mailing Address
First Line : 3539 DOUGLAS DR N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55422-2415
Country : US
Telephone Number : 612-642-1355
Fax Number : 612-756-7059
Provider Business Practice Location Address
First Line : 3539 DOUGLAS DR N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55422-2415
Country : US
Telephone Number : 612-642-1355
Fax Number : 612-756-7059
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2008
Last Update Date : 01/14/2021

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