Healthcare Provider Details

I. General information

NPI: 1194164012
Provider Name (Legal Business Name): DR. LISA H PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 GLEN RD
JENKINTOWN PA
19046-1529
US

IV. Provider business mailing address

16 SAGAMORE HILL RD
OYSTER BAY NY
11771-1807
US

V. Phone/Fax

Practice location:
  • Phone: 516-210-6464
  • Fax:
Mailing address:
  • Phone: 631-807-6487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020827
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS020617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: