Provider Demographics
NPI:1053417097
Name:PINTO, LISA A (PSYD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:PINTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-0387
Mailing Address - Country:US
Mailing Address - Phone:630-416-6056
Mailing Address - Fax:
Practice Address - Street 1:1288 RICKERT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0951
Practice Address - Country:US
Practice Address - Phone:630-416-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2204872OtherBCBS PROVIDER NUMBER
IL994300Medicare ID - Type Unspecified