Healthcare Provider Details

I. General information

NPI: 1043282635
Provider Name (Legal Business Name): LISA MARIE POPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTHGATE SQ
GREENSBURG PA
15601-1341
US

IV. Provider business mailing address

1 NORTHGATE SQ
GREENSBURG PA
15601-1341
US

V. Phone/Fax

Practice location:
  • Phone: 724-834-9305
  • Fax: 724-834-9305
Mailing address:
  • Phone: 724-834-9305
  • Fax: 724-834-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013855
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: