MEDICARE: LISA MICHELLE DELANEY M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	2003018907	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	310348832	OTHER	MO	BNDD

General Provider Information

NPI Number	:	1962531855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MICHELLE DELANEY M.D.

Provider Business Mailing Address
First Line	:	1800 COMMUNITY
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-8804
Country	:	US
Telephone Number	:	660-885-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 DEADRA DR
Second Line	:
City	:	LEBANON
State	:	MO
Zip	:	65536-4669
Country	:	US
Telephone Number	:	888-403-1071
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	03/07/2023

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