Healthcare Provider Details

I. General information

NPI: 1053907998
Provider Name (Legal Business Name): LISA GARNETT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E BRINGHURST ST
PHILADELPHIA PA
19144-1799
US

IV. Provider business mailing address

251 E BRINGHURST ST
PHILADELPHIA PA
19144-1799
US

V. Phone/Fax

Practice location:
  • Phone: 215-844-1020
  • Fax: 215-844-2702
Mailing address:
  • Phone: 215-844-1020
  • Fax: 215-844-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ3-0010453
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: