Healthcare Provider Details

I. General information

NPI: 1235293887
Provider Name (Legal Business Name): LISA R DELANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 BENTON RD
PADUCAH KY
42003-1304
US

IV. Provider business mailing address

6201 BENTON RD
PADUCAH KY
42003-1304
US

V. Phone/Fax

Practice location:
  • Phone: 270-908-0461
  • Fax: 270-366-0780
Mailing address:
  • Phone: 270-908-0461
  • Fax: 270-366-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number288470
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: