Healthcare Provider Details

I. General information

NPI: 1437798287
Provider Name (Legal Business Name): LISA REPASKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 BENTIVAR DR
CHARLOTTESVILLE VA
22911-8227
US

IV. Provider business mailing address

1780 BENTIVAR DR
CHARLOTTESVILLE VA
22911-8227
US

V. Phone/Fax

Practice location:
  • Phone: 614-800-5685
  • Fax:
Mailing address:
  • Phone: 614-800-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW0904008809
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: