Healthcare Provider Details

I. General information

NPI: 1164607222
Provider Name (Legal Business Name): LISA A. AHERN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 MARKET STREET SUITE 200
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3440 MARKET STREET SUITE 200
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7555
  • Fax: 215-590-7387
Mailing address:
  • Phone: 215-590-7555
  • Fax: 215-590-7387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3455
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: