MEDICARE: LISA IRENE THOMAS EL LCADC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	37LC00223900	NJ

General Provider Information

NPI Number	:	1194510891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA IRENE THOMAS EL LCADC

Provider Business Mailing Address
First Line	:	1251 N OHIO AVE APT 1
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-1825
Country	:	US
Telephone Number	:	252-665-6795
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 TILTON RD UNIT 5147
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-1831
Country	:	US
Telephone Number	:	800-484-1890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2025
Last Update Date	:	04/12/2025

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