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NPI Code Detail

MEDICARE: DR. LISA MARIE KING PSY.D., MSW, LP, CAP

MEDICARE: DR. LISA MARIE KING PSY.D., MSW, LP, CAP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor6801078040MI
2101YM0800XMental Health Counselor6801078040MI
31041C0700XClinical Social Worker6801078040MI
4103TC0700XClinical PsychologistPY9434FL
5103TA0400XAddiction (Substance Use Disorder) PsychologistPY9434FL
6103TB0200XCognitive & Behavioral PsychologistPY9434FL
7101YA0400XAddiction (Substance Use Disorder) Counselor010141-2015FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043359193
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA MARIE KING PSY.D., MSW, LP, CAP
Provider Business Mailing Address
First Line : 950 6TH AVE N
Second Line :
City : NAPLES
State : FL
Zip : 34102-5633
Country : US
Telephone Number : 239-659-2345
Fax Number :
Provider Business Practice Location Address
First Line : 950 6TH AVE N
Second Line :
City : NAPLES
State : FL
Zip : 34102-5633
Country : US
Telephone Number : 239-659-2345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 11/09/2015

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