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General NPI Number Information
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NPI Number | 1477714558
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Entity Type | Individual
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Provider Name | LISA FERN HARRISON MSW
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Gender | Female
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 115 FARABEE DR N SUITE C
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City | LAFAYETTE
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State | IN
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Zip | 47905-5913
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Country | US
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Telephone | 765-423-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 4041 AMETHYST DR
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City | LAFAYETTE
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State | IN
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Zip | 47909-8084
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Country | US
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Telephone | 765-807-5379
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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