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General NPI Number Information
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NPI Number | 1275066466
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Entity Type | Individual
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Provider Name | LISA MARIE LAGALA NCC, LPC, ACS
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Gender | Female
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 1049 BROADWAY
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1334
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Country | US
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Telephone | 732-852-7750
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Fax | 732-454-5325
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Provider Business Mailing Address
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Address Line | 104 BAYARD ST
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-2389
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Country | US
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Telephone | 732-847-2869
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Fax | 732-851-1031
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00595400
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License Number State | NJ
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