Provider Demographics
NPI:1053789230
Name:HAHN, LISA (PHD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-4404
Mailing Address - Country:US
Mailing Address - Phone:201-638-7881
Mailing Address - Fax:
Practice Address - Street 1:916 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-4404
Practice Address - Country:US
Practice Address - Phone:201-638-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9328103G00000X
NJ4625103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist