Healthcare Provider Details

I. General information

NPI: 1104056894
Provider Name (Legal Business Name): LISA A JAMES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MENNONITE CHURCH RD
SPRING CITY PA
19475-1518
US

IV. Provider business mailing address

15B DORAL DR
READING PA
19607-3388
US

V. Phone/Fax

Practice location:
  • Phone: 610-948-6490
  • Fax:
Mailing address:
  • Phone: 610-812-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW-011838-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: