Provider Demographics
NPI:1053591677
Name:TRIPPI, LISA VIOLETTE (EI DEV SPECIALIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:VIOLETTE
Last Name:TRIPPI
Suffix:
Gender:F
Credentials:EI DEV SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 LAKE FOREST PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8047
Mailing Address - Country:US
Mailing Address - Phone:508-826-3299
Mailing Address - Fax:
Practice Address - Street 1:62 LAKE FOREST PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8047
Practice Address - Country:US
Practice Address - Phone:508-826-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222Q00000X222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist