MEDICARE: MRS. LISA CAROL PERLINE LCSW

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
1	1041C0700X	Clinical Social Worker	44SC05491200	NJ

General Provider Information

NPI Number	:	1396408365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA CAROL PERLINE LCSW

Provider Business Mailing Address
First Line	:	30 EAST DR
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-3503
Country	:	US
Telephone Number	:	917-439-0367
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 E NORTHFIELD RD STE D2L
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-4533
Country	:	US
Telephone Number	:	973-306-4212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	06/23/2026

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