Provider Demographics
NPI:1679309223
Name:MCCARTNEY, LISA SHANNON
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SHANNON
Last Name:MCCARTNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E EVANS ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2660
Mailing Address - Country:US
Mailing Address - Phone:215-370-9243
Mailing Address - Fax:
Practice Address - Street 1:109 E EVANS ST STE 105
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2660
Practice Address - Country:US
Practice Address - Phone:215-370-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health