| Lisa M Pupa Phd Llc | |
|
2164 Highway 35 Bldg B Sea Girt NJ 08750-1013 | |
| (732) 359-7675 | |
| (732) 359-7674 |
| Full Name | Lisa M Pupa Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2164 Highway 35 Bldg B, Sea Girt, New Jersey |
| Authorized Official Name and Position | Lisa M Pupa-o'sullivan (OWNER OPERATOR) |
| Authorized Official Contact | 7323597675 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa M Pupa Phd Llc 2164 Highway 35 Bldg B Sea Girt NJ 08750-1013 Ph: (732) 359-7675 | Lisa M Pupa Phd Llc 2164 Highway 35 Bldg B Sea Girt NJ 08750-1013 Ph: (732) 359-7675 |
| NPI Number | 1992012405 |
|---|---|
| Provider Enumeration Date | 09/03/2010 |
| Last Update Date | 09/03/2010 |
| Medicare PECOS PAC ID | 4880710136 |
|---|---|
| Medicare Enrollment ID | O20100924000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992012405 | NPI | - | NPPES |
| P00667132 | Other | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 35SI00351200 (New Jersey) | Primary |
| Provider Name | Lisa M Pupa-osullivan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932156320 PECOS PAC ID: 4688616386 Enrollment ID: I20050524000076 |
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