1043323785 NPI number — MS. LISA KRISTEN VILLANO MA, LPC, LCADC

Table of content: (NPI 1649346719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043323785 NPI number — MS. LISA KRISTEN VILLANO MA, LPC, LCADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLANO
Provider First Name:
LISA
Provider Middle Name:
KRISTEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, LCADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043323785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 VISTA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR KNOLLS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07927-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-879-8982
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 CENTURY DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARSIPPANY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07054-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-296-0630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  37LC00123900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 37PC00300600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)