Healthcare Provider Details

I. General information

NPI: 1689216764
Provider Name (Legal Business Name): LISA MARIE ISLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MADISON AVE
MORRISTOWN NJ
07960-7366
US

IV. Provider business mailing address

31 ARNOLD DR
RANDOLPH NJ
07869-3304
US

V. Phone/Fax

Practice location:
  • Phone: 973-796-3760
  • Fax:
Mailing address:
  • Phone: 973-769-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37AC00491700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: