MEDICARE: LISA A EATON PSYD

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	103G00000X	Clinical Neuropsychologist	PS008265L	PA

General Provider Information

NPI Number	:	1891761938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA A EATON PSYD

Provider Business Mailing Address
First Line	:	1135 OLDE W CHOCOLATE AVE
Second Line	:	SUITE 101
City	:	HUMMELSTOWN
State	:	PA
Zip	:	17036-9188
Country	:	US
Telephone Number	:	800-243-1455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 OLDE W CHOCOLATE AVE
Second Line	:	SUITE 101
City	:	HUMMELSTOWN
State	:	PA
Zip	:	17036-9188
Country	:	US
Telephone Number	:	800-243-1455
Fax Number	:

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	09/17/2015

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