1245361807 NPI number — DR. LISA GUNDERSHEIMER PHD, LCSW

Table of content: DR. LISA GUNDERSHEIMER PHD, LCSW (NPI 1245361807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245361807 NPI number — DR. LISA GUNDERSHEIMER PHD, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNDERSHEIMER
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARON
Provider Other First Name:
LISA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD, LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245361807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 W MAIN ST
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
CARRBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27510-1694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-988-0353
Provider Business Mailing Address Fax Number:
919-710-8219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 W MAIN ST
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
CARRBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27510-1694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-988-0353
Provider Business Practice Location Address Fax Number:
919-710-8219
Provider Enumeration Date:
03/07/2007

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: 1041C0700X , with the licence number:  C008654 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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