Healthcare Provider Details

I. General information

NPI: 1104030584
Provider Name (Legal Business Name): LISA KATHLEEN MORAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SAVANNAH CHASE CIR APT 304
GARNER NC
27529-5217
US

IV. Provider business mailing address

1200 SAVANNAH CHASE CIR APT 304
GARNER NC
27529-5217
US

V. Phone/Fax

Practice location:
  • Phone: 919-773-3739
  • Fax: 919-733-5869
Mailing address:
  • Phone: 919-773-3739
  • Fax: 919-733-5869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCOO5560
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: