Healthcare Provider Details

I. General information

NPI: 1619479573
Provider Name (Legal Business Name): LISA P HAVERSTICK RDN,CNSC,FAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SOUTH ST STE 330
MORRISTOWN NJ
07960-6472
US

IV. Provider business mailing address

435 SOUTH ST STE 330
MORRISTOWN NJ
07960-6472
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7101
  • Fax: 973-290-7518
Mailing address:
  • Phone: 973-971-7101
  • Fax: 973-290-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: