Provider Demographics
NPI:1679532584
Name:CRISPINO, LISA (LPC LCADC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CRISPINO
Suffix:
Gender:F
Credentials:LPC LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BROAD STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735
Mailing Address - Country:US
Mailing Address - Phone:732-888-4480
Mailing Address - Fax:732-888-4485
Practice Address - Street 1:16 BROAD STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735
Practice Address - Country:US
Practice Address - Phone:732-888-4480
Practice Address - Fax:732-888-4485
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00075500101YA0400X
NJ37PC00022400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)